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Structural basis for endotoxic and antagonistic activities: investigation with novel synthetic lipid A analogs.

Our early work using homogeneous synthetic preparations demonstrated the presence of a lipid A analog which antagonizes endotoxic activities of LPS and lipid A. The first example was a tetraacylated biosynthetic precursor, now known as precursor Ia or lipid IVa, that contains four 3-hydroxytetradecanoyl moieties linked to the bisphosphorylated disaccharide backbone common to the endotoxic hexa-acyl Escherichia coli lipid A. Various compounds with both endotoxic and antagonistic activities have subsequently been reported from either natural or synthetic sources, but little is known about the factors determining the type of the activities of the respective compounds. To approach this issue, we have synthesized a series of lipid A analogs with various numbers and chain lengths of acyl groups on the backbone. Some were prepared by the aid of a novel affinity separation procedure. The phosphate moieties were also synthetically replaced. Biological tests showed that at least three acyl groups are required for antagonistic activity but one or even both of the phosphates can be replaced with other acidic moieties without losing the activity. The effect of Kdo residues linked to lipid A is also briefly discussed. Molecular dynamics calculations reasonably explain possible conformations required for the biological activity.

Blood Cells↗

Bacterial endotoxin isolated from a water spray air humidification system as a putative agent of occupation-related lung disease.

Outbreaks of hypersensitivity pneumonitis or humidifier fever were attributed to the inhalation of organic material aerosolized by a chilled-water spray humidification system. The purpose of this study was to isolate and characterize the serologically detectable antigen(s) present in extracts obtained from the humidification system. By using bicarbonate or phenol-water extractions or both, the antigen was isolated and characterized, using colorimetry, gas-liquid chromatography, reverse-phase high-performance liquid chromatography, and X-ray fluorescence. Carbohydrates, hexosamines, phosphorus, and even-numbered saturated and unsaturated fatty acids were constituents of the serologically detectable antigen. When tested in in vivo and in vitro assays, the antigen had demonstrable endotoxin activity. All subjects with biopsy-proven lung disease and a majority of subjects suspected of having lung disease had antibodies directed toward the purified endotoxin. The data strongly suggest that an aerosolized bacterial endotoxin is a putative agent inducing lung disease.

Alveolitis, Extrinsic Allergic↗

Resolving LAL Test interferences.

A greater understanding of the nature of LAL-Test interferences and the use of permissible dilution have minimized inhibition problems. Common interference mechanisms include suboptimal pH, endotoxin aggregation or adsorption, container effects, unbalanced cation concentration, enzyme or protein modification, and non-specific LAL activation. Dilution is the best approach to resolving interferences because over 90% are concentration dependent and are solved by the 1:40 dilution with LAL Reagent Water. Other problems are approached by using dilution plus a specific pretreatment procedure designed to neutralize the offending mechanism.

Drug Contamination↗

In vitro effects of novel glycopeptide antibiotics on the reactivity of the lipopolysaccharide (LPS) of S. minnesota R595.

Four novel glycopeptide antibiotics, namely MDL 62708, MDL 63155, MDL 62827, MDL 62873 (mideplanin), plus teicoplanin, which differ in their chemical structure, were used to examine the relationship between the structure of glycopeptides and their LPS neutralization activity. Compound MDL 62708 (100 micrograms/ml) significantly reduced (P < 0.01 vs. antibiotic-free LPS, by Fisher's PLSD Test) metachromatic reactivity of S. minnesota R595 LPS (500 micrograms/ml) as evaluated by the DMB test. The remaining glycopeptides showed a significant reduction of the metachromatic reactivity, although at concentrations (333 and 1000 micrograms/ml) higher than MDL 62708. Data obtained with LAL test appeared in accordance with those of the other techniques: all the glycopeptides used (100 and 1000 micrograms/ml) significantly (P < 0.05) reduced the reactivity of S. minnesota R595 LPS (50 pg/ml), and the lowest concentration of MDL 62708 (10 pg/ml) used produced a substantial, although not significant, reduction of the LPS reactivity with LAL. The antibiotic/LPS ratios associated to a significant reduction of LPS reactivity were 3.3/5 (wt/wt) and 2/1 (wt/wt) for DMB and LAL tests respectively. Such ratio appeared to be even lower for MDL 62708. In conclusion, the four new glycopeptides, when tested at an antibiotic/LPS ratio about 1000 times lower than that which can be found in vivo, were able to reduce the reactivity of LPS in the in vitro models used. Teicoplanin aglycone MDL 62708, which also lacks the teicoplanin fatty acid, seems to have the same anti-LPS activity as the parental antibiotic, thus suggesting an important role for the glycopeptide backbone and NH2 groups in LPS-neutralizing effect.

Analysis of Variance↗

Relation of structure to function for the U. S. reference standard endotoxin after exposure to 60Co radiation.

The structure and function of the highly purified U.S. reference standard endotoxin (RSE) were studied after exposure to ionizing radiation from a 60Co source. With increasing doses of radiation, the trilaminar ribbon-like structure of untreated endotoxin exhibited focal swelling, after which only spherical particles were seen by electron microscopy. These morphological changes were paralleled by the respective loss of O-side chain repeating units and pieces of the R-core from the lipopolysaccharide molecules, as demonstrated by electrophoresis. The biologic function of the irradiated endotoxin was assessed with a variety of tests. At higher doses of radiation, a direct relation was observed between the degradation of the molecular and supramolecular structure and the loss of biologic function. At lower doses of radiation, however, there was variability among the functional assays in their rate of change with progressive irradiation of the RSE. The results suggest that the carbohydrate moiety plays an important role both in determining the supramolecular structure and in modulating certain biologic activities of bacterial endotoxins.

Animals↗

Effect of detoxification processes on the interferon-inducing activity of bacterial endotoxins.

The interferon (IFN)-inducing activity of detoxified lipopolysaccharide (LPS) was tested in rabbits treated with LPS preparation derived from Escherichia coli, Salmonella typhi, Salmonella enteritidis and Shigella dysenteriae serovar 1. Of the detoxification procedures used, alkaline hydrolysis, hydroxylaminolysis, formalization, treatment with sodium deoxycholate and the radiodetoxification (fast or slow) methods had no appreciable effects on the IFN-inducing potential of LPS. In contrast, acetylation or prolonged alkaline hydrolysis of LPS resulted in up to a 9-fold reduction of IFN-induction capacity and effects of Cu++ or Fe++ cations bound to LPS were clearly inhibitory (Fe more than Cu).

Acetylation↗

Immunogenicity of capsular antigens of Pasteurella multocida in turkeys.

Capsular antigens were isolated from Pasteurella multocida, strain P-1059 and their immunogenicity was tested in turkeys. The crude capsular antigen (CCA) was extracted from bacterial cells grown on membranes by heating at 56 C in a 2.5% NaCl solution. The purified polysaccharide antigen (PPA) was obtained by precipitation of CCA by cetylpyridinium chloride. Young adult turkeys were inoculated at 0 and 14 days and were challenge exposed at 28 days by IM inoculation of a live culture of P-1059. The turkeys were observed for 2 weeks and mortality was recorded; bacterial isolation was done at the time of necropsy. In 3 trials, CCA provided 80% to 100% protection; in 1 trial, PPA failed to provide protection. Freund's incomplete adjuvant and aluminum hydroxide gel were effective as potentiating agents when higher than 280 microgram of CCA was used. The CCA showed significant (P less than 0.05) protection after treatment with heat (100 C, 5 min), chloroform, or trypsin, but lost its immunogenicity completely by acid hydrolysis. The CCA was not toxic to mice at 2 mg. The limulus lysate test showed that CCA contained endotoxin in less than or equal to 5% of the total solids. These results indicate that the surface antigen isolated from P multocida by saline extraction was immunogenic in young adult turkeys.

Aluminum Hydroxide↗

Assay of pertussis vaccine reactivity factors by measurement of the paw swelling response, endotoxin and histamine-sensitizing factor.

Bordetella pertussis is composed of a series of active components: (1) a heat-labile or dermonecrotic toxin (HLT); (2) a lipopolysaccharide endotoxin (LPS); (3) pertussis toxin; (4) filamentous hemagglutinin (FHA); (5) agglutinogens; (6) outer membrane proteins; (7) adenylate cyclase; and (8) tracheal cytotoxin. Pertussis toxin (PT), also called lymphocytosis-promoting factor (LPF), encompasses a series of biological activities including: (1) histamine-sensitization (HSF); (2) leukocytosis-promoting activity (LPF); (3) LPF-hemagglutinin (LPF-HA); and (4) pancreatic islet-activating protein (IAP). The heat-labile toxin is inactivated during vaccine production. Pertussis toxin is inactivated when heated to 80 degrees C for 30 min and endotoxin at a temperature greater than 120 degrees C for 30 min. The effect of pre- and post-heat treatment on DTP vaccine, Bordetella pertussis endotoxin, pertussis toxin and a pertussis toxin/endotoxin combination, was determined as related to: (1) paw swelling response; (2) LAL activity (endotoxin); and (3) HSF activity. With the exception of DTP and B. pertussis endotoxin, the average paw swelling response after injection of non-treated and heat-treated test samples was similar to the saline control at all measured time intervals. Contrary to anticipated results, heat treatment enhanced the paw-swelling response of DTP vaccine and B. pertussis endotoxin. Endotoxin levels, as measured by LAL, were significantly lower after heat-treatment, with the exception of B. pertussis endotoxin and the E-1 control. The addition of pertussis toxin, B. pertussis endotoxin or pertussis toxin/endotoxin did not restore LAL values to the levels seen for non-treated DTP vaccine.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenylate Cyclase Toxin↗

Nitroglycerin injection manufactured by a hospital pharmacy.

A method used by a hospital pharmacy department for manufacturing and testing a ready-to-administer i.v. nitroglycerin injection is described, and costs for this extemporaneously prepared injection are compared with costs for commercially available nitroglycerin products for i.v. use. A powder adsorbate containing one part nitroglycerin and nine parts lactose was used to prepare nitroglycerin injection in two strengths: 0.04 mg/mL (250-mL quantities) in 0.9% sodium chloride injection and 0.4 mg/mL (400-mL quantities) in 5% dextrose injection. Each batch was tested for sterility, for presence of pyrogens (endotoxin testing), and for nitroglycerin concentration (spectrophotometric assay). In one year, a total of 1217 bottles of nitroglycerin injection were prepared. This required 75 hours; preparation from commercial i.v. nitroglycerin products would have required approximately 200 hours (including admixture preparation). First-year costs for extemporaneous preparation (excluding costs of i.v. solutions and containers) were approximately $2200, far less than drug costs alone for the commercial i.v. nitroglycerin products. Nitroglycerin injection of high quality and confirmed potency was prepared extemporaneously in a hospital pharmacy department. Costs for this method were substantially less than those for use of commercial i.v. nitroglycerin products.

Costs and Cost Analysis↗

Permeability and adsorption capacity of dialysis membranes to lipid A.

Hemodialysis membranes were tested in vitro for possible penetration by low molecular weight endotoxins containing lipid A. Using lipid A from Escherichia coli as a model substance for this kind of pyrogen, different dialyzers (F4, E3. Acepal 1300, Altraflux, F 40, Polyflux 110, Filtral 12, F 60) were challenged by tangential filtration in aqueous medium. All membranes exhibited impermability to lipid A (as well as to LPS from Pseudomonas aeruginosa), which was proved by additional experiments using culture filtrates of Pseudomonas aeruginosa in bicarbonate dialysis fluid, as well as by employing miniaturized dialyzers with synthetic lipid A as a contaminant. Furthermore, the highest adsorption capacities were found for polysulfone and polyamide membranes.

Adsorption↗

In vitro pyrogenicity of the diphtheria, tetanus and acellular pertussis components of a trivalent vaccine.

We have earlier found that a trivalent vaccine, containing antigenic components from both Gram-positive and Gram-negative bacteria, induced secretion of the endogenous pyrogen interleukin 6 (IL-6) when added to fresh human blood in vitro. The results of the present study showed that the IL-6 secretion was induced by toxoids derived from the Gram-positive bacterium Corynebacterium diphtheriae. However, fresh whole blood from different donors reacted differently to the stimulation. The blood from some donors induced secretion of large concentrations of IL-6, while the blood from other donors induced essentially no IL-6 secretion as a response to stimulation with diphtheria toxoid or a mixture of diphtheria and tetanus toxoids. Repeated testing over several years using blood from the same donor confirmed a donor-dependency of the reaction. This donor-dependency was only found for the toxoid, since blood from all donors reacted with approximately similar IL-6 production to stimulation by endotoxin from the Gram-negative bacterium Escherichia coli, known to be mediated via the toll-like receptor (TLR) 4. Also, no donor-dependecy was found to highly purified lipoteichoic acid from the Gram-positive bacteria Bacillus subtilis and Staphylococcus aureus, known to be mediated via TLR-2 and TLR-6. The receptors involved in stimulation by diphtheria toxoid are not known, but may differ from those used by endotoxin and lipoteichoic acid.

Antibodies, Bacterial↗

Is steam sterilization really making any difference in dialysis-induced cytokine release?

Ethylene oxide (ETO) is presently the most commonly used sterilization method for medical devices. Although alternative sterilization modes such as steam sterilization have been suggested, the effect of steam on dialysis-induced cytokine release is unknown. We enrolled 9 patients on chronic hemodialysis and evaluated at different intervals IL-1beta production while treated with ETO (NC 1785-Bellco) and steam sterilized NC 1785S-Bellco) Synthetically Modified Cellulose (SMC). A basal test during treatment with NC 1785 was performed (A); the same test was set up 4 weeks after treatment with NC 1785S (B) and, lastly, 4 weeks after returning to NC 1785 (C). Peripheral blood mononuclear cells (PBMC) were purified before and after the dialysis session, were isolated on a Ficoll/Hypaque gradient and incubated for 24 h. Spontaneous IL-1beta release was evaluated in the supernatant and in the lysate. In A, IL-1beta levels were (in pg/ml/10(6) cells, in supematant and lysate, respectively): 5.8 +/- 4.8 and 7.6+/-5.2 in pre-HD and 4.68 +/- 3.6 and 9.7 +/- 6.65 in post-HD. These levels showed a clear reduction in B: 2.5 +/- 2.2 and 4.4 +/- 3.1 in pre-HD, and 4.35+/- 6.6 and 7.52 +/- 7.22 in post-HD. In the C test, 4 weeks after the return to the ETO membrane, IL-1beta levels remained unchanged: 2.9 +/- 1.8 and 4.5 +/- 3.1 in pre-HD; and 2.6 +/- 3 and 5.7 +/- 6.6 in post-HD. Statistical analysis showed significant changes in the pre-HD levels both in supematant (p < 0.04) and in lysate (p < 0.04). Steam sterilization of SMC induced a lower spontaneous IL-1beta release, but this effect was not statistically significant due to the large inter-individual variation. Hence, contrary to claims of better biocompatibility, steam sterilization does not result in a reduced production of pro-inflammatory IL-1beta.

Biocompatible Materials↗

Lymphocyte mitogenic factor in sera from patients with falciparum malaria.

To test for the presence of a lymphocyte mitogenic factor in malaria, sera were obtained from 10 patients with malaria (9 with falciparum and one with vivax), and 10 noninfected controls. The sera from the malarial patients caused an increased blastogenesis in mouse splenic lymphocyte cultures and inhibited hemagglutination between lipid-A-coated erythrocytes and lipid-A antibodies. None of the sera were positive using the limulus amebocyte lysate test. These results could be interpreted to demonstrate that patients with falciparum malaria have a circulating mitogen which cross-reacts with endotoxin. However, alternate explanations must be considered, including an hypothesis that antiglobulins and/or immune complexes in the sera of malarious patients both caused the blastogenesis of mouse spleen cells and inhibited hemagglutination to lipid-A antibodies.

Adult↗

Hepatocyte transplantation--in vitro cytotoxic reaction of autologous granulocytes and mononuclears to isolated hepatocytes.

UNLABELLED: Hepatocyte (HC) transplantation (tx) may be useful for bridging patients to whole organ transplantation and for providing metabolic support during liver failure and for replacing whole organ transplantation in certain liver metabolic diseases. In specific situations where the death rate of host hepatocytes is high, the transplanted cells can repopulate the native liver. Successful transplantation of hepatocytes is hampered by lack of proper cellular (stromal) and humoral (cytokines) environment at the site of implantation. We have found that another factor responsible for low in vivo survival rate of transplanted HC is their rapid destroying by host granulocytes and monocytes. AIM. In this study we investigated the in vitro process of destruction of HC by granulocytes and mononuclear cells, the phenotypes of effector mononuclears and the tempo of HC lysis. METHODS: In vitro cell-mediated cytotoxicity, HC-PMN and HC-PBM rosette formation rate and HC lysis, as well as phenotypes of HC-adhering cells were investigated. RESULTS: Granulocytes formed rosettes with HC almost immediately after the beginning of incubation and were found highly cytotoxic to HC. The cellular mechanism of lysis was not mediated by serum natural antibodies. Also the in vitro mixed HC-granulocyte 51Cr test showed high granulocyte cytolytic activity. Monoclonal antibodies to class I and II antigens, CD11/18 and 54 did not block the granulocyte cytotoxicity. Blood mononuclear cells also formed rosettes with HC and were cytotoxic to them, but the level of cytotoxicity was lower than of granulocytes. ED1+ monocytes revealed highest cytolytic activity toward HC. Hepatocyte contained only trace levels of endotoxin and no chemotactic activity of granulocytes and monocytes toward HC could be observed. CONCLUSIONS: A random physical contact of blood leukocytes seems necessary for adhesion to isolated HC. Taken together, granulocytes and monocytes recognize intercellular surface molecules on HC "exposed during isolation" from the hepatic trabeculae as "non-self" and lyse HC by direct contact.

Animals↗

[Preliminary data concerning cross-reacting anticardiolipin antibodies as potential inhibiting endotoxin activity factors].

In analyzed synovial fluids, suspected for endotoxin presence, the presence of endotoxin done was proved by LAL-test in 21 synovial fluids /42%/ and in 12 of 20 /60%/ the presence of endotoxin inhibiting substances /IS/ was proved. Because many parameters /like presence CIC, anti-LPS, KDO/ indicates that in the group of LAL-negative /IS/ - positive synovial fluids the presence of endotoxin is very possible, IS have been removed /by heating to 100 degrees C/ and after that the endotoxin activity was shown in about 27% of synovial fluids. Additional analysis of the Cohn fraction /prepared by ammonium sulfate precipitation/ confirmed the presence in the gamma and alpha and beta fractions a weak IS activity /in a dose dependent manner. No IS activity, have been shown yet in the fraction of affinity purified aCl antibodies.

Antibodies, Anticardiolipin↗

Requirement of a properly acylated beta(1-6)-D-glucosamine disaccharide bisphosphate structure for efficient manifestation of full endotoxic and associated bioactivities of lipid A.

Several synthetic acylated glucosamine monophosphates, with structures corresponding to the nonreducing or reducing moiety of the lipid A of the Escherichia coli or Salmonella minnesota type, and a synthetic compound corresponding to a biosynthetic disaccharide lipid A precursor (designated Ia or IVA) were examined for their endotoxic and related bioactivities in comparison with those of the synthetic and bacterial parent molecules, i.e., acylated beta(1-6)-D-glucosamine disaccharide bisphosphates. Some of the test monosaccharide compounds were definitely active in most of the in vitro assays. Their activities, except for complement activation, however, were weaker than those of the reference compounds, synthetic and bacterial acylated disaccharide bisphosphates. The differences between the test monosaccharide and disaccharide compounds were much more apparent in in vivo assays, in which the test acylated glucosamine monophosphates were scarcely active, though some test compounds exhibited weak lethal toxicity in galactosamine-loaded mice and were weakly active in pyrogenicity, immunoadjuvant activity, and possible tumor necrosis factor and alpha and beta interferon-inducing ability in Mycobacterium bovis BCG- and Propionibacterium acnes-primed mice, respectively. Mixture at an equimolar ratio of acyl glucosamine monophosphates, each of which has the structure of the reducing or nonreducing moiety of the reference disaccharide compound, did not restore the endotoxic or associated bioactivities of the corresponding parent molecules. No essential differences in bioactivity were noted between synthetic and bacterial monosaccharide compounds, i.e., lipid X, whose structure corresponds to the reducing moiety of E. coli-type lipid A.

Acylation↗

Preparation and use of endotoxin indicators for depyrogenation process studies. LAL Users Group.

Biological Indicators (B.I.'s) have traditionally been employed in the validation and routine monitoring of sterilization processes used for the manufacture and control of pharmaceuticals and medical devices. In this paper, the phrase "Endotoxin Indicator" has been coined to describe a tool analogous to the BI which can be used in the validation and routine control of endotoxin reduction processes. Like the BI, the Endotoxin Indicator provides the user with an in vitro biological test to complement physical measurement used to control the manufacturing process. It must be remembered that the total pyroburden in an aseptically processed drug is the sum of the pyroburden of each factor contributing to the manufacture of that product. This includes raw materials, packaging components, the environment and the manufacturing process itself. Therefore, all aspects of the process must be considered for a complete validation. This pyroburden may also change during processing of a drug. Fluctuations in pH, solvent content, and temperature may decrease pyroburden while introduction of some raw materials, especially water, may increase endotoxin content. Regularly scheduled monitoring of all aseptic processes should identify and address each step of the process considered to have potential for the possible introduction or removal of endotoxin in the final product. Most of these situations can be thoroughly studied using Endotoxin Indicators to challenge routine production conditions, thereby providing insight to the assurance of endotoxin-free final products.

Endotoxins↗

Polymyxin B-conjugated alpha 2-macroglobulin as an adjunctive therapy to sepsis: Modes of action and impact on lethality.

A drug targeting both the inflammatory initiators (lipopolysaccharide; LPS) and mediators [tumor necrosis factor-alpha (TNF-alpha)] should have advantage over a "single-factor targeting strategy" in sepsis prevention trials. We have prepared conjugates of polymyxin B (PMB) and the cytokine binding protein alpha2-macroglobulin (A2M). The conjugate binds TNF-alpha as well as LPS as studied by electrophoresis and phase partitioning. Compared with free PMB, the conjugate is nontoxic to cells and does not affect the viability of human monocytes. The A2M-PMB conjugate binds to the A2M receptor (CD91/low-density lipoprotein receptor-related protein 1) with affinity similar to that of the nonmodified protein. Fluorescein isothiocyanate-labeled LPS in the presence of A2M-PMB is rapidly transported into fibroblasts for degradation via receptor-mediated endocytosis. In vitro, A2M-PMB demonstrated inhibition of LPS-induced secretion of TNF-alpha from isolated monocytes as well as in the whole blood assay. The efficacy of the drug was tested in mice after induction of acute inflammation (LPS model) and after induction of a polymicrobial sepsis by cecal ligation and puncture (CLP) model. Treatment of mice with A2M-PMB up to 250 microg/g body weight was not toxic to the animal. When the drug was administered 30 min before or 30 min after the LPS challenge, a survival rate of 90 and 70%, respectively, was obtained compared with the placebo control group (5%). A2M-PMB also protected mice after induction of polymicrobial sepsis when administered 30 min before CLP. These results support our hypothesis that A2M-PMB acts as a polyvalent drug to target different host mediators as well as sepsis inducer at the same time.

Animals↗