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Picogram quantities of anti-Ig antibodies coupled to dextran induce B cell proliferation.

To investigate the properties which enable type 2 Ag, as exemplified by dextran and Ficoll, to stimulate high levels of antibody responses in the relative absence of T cells, we conjugated anti-IgD and anti-IgM mAb to both dextran and Ficoll and examined their B cell-activating properties. Such conjugated anti-Ig antibodies stimulated both early and later stages of B cell activation at picogram concentrations, which are at least 1000-fold lower than that required for B cell stimulation by unconjugated anti-Ig antibodies, and the level of proliferation they stimulated was on average 10-fold greater. Furthermore, concentrations of anti-Ig dextran (100 pg/ml) which modulated little sIgD from the B cell surface were strong inducers of enhanced B cell expression of MHC class II molecules. Conjugation of Fab fragments of anti-IgD or nonmitogenic anti-IgM mAb to dextran rendered them as mitogenic as dextran conjugated to strongly stimulatory anti-IgD or anti-IgM antibodies. The ability of dextran and Ficoll to serve as effective carrier molecules for anti-IgD was not related solely to their large m.w., because anti-IgD coupled to polymerized BSA (m.w. 1.5 X 10(6), was only 10- to 50-fold more potent than unconjugated anti-IgD antibodies at stimulating B cell DNA synthesis. These results suggest, therefore, that the unique ability of picogram concentrations of haptenated type 2 Ag to stimulate Ig secretion in the absence of T cells may be a function of their ability to promote effective cross-linking without resulting in the modulation of sIg. This would enable such Ag to mediate repetitive B cell signaling, a situation that cannot be achieved by unconjugated anti-Ig antibodies which result in modulation of sIg at their mitogenic concentrations. These compounds therefore may be employed to study B cell activation stimulated by sIg cross-linking at concentrations that may more closely reflect those which are achieved under physiologic conditions by type 2 Ag.

Animals↗

The antithrombotic efficacy of dextran.

Dextran was introduced as early as 1944 as a plasma substitute. Since 1962 dextran has also proved to be effective as a prophylactic agent against postoperative thrombo-embolism. In general surgery low-dose heparin (LDH) is more effective in preventing isotopic deep-vein thrombosis diagnosed by the radioactive fibrinogen test, but in orthopaedic surgery dextran is superior to heparin. Dextran seems equally effective as LDH in preventing fatal pulmonary embolism both in general and orthopaedic surgery. In routine surgery, infusion of 500-1,000 ml of dextran will replace the first blood loss of 500-800 ml without risk of transmitting diseases. Simultaneously thrombo-embolic prophylaxis will be achieved with a decreased risk of haemorrhagic complications than is seen with heparin prophylaxis. The risk for severe anaphylaxis to dextran is minimal today (approx. 1 case in every 40,000 treated patients) thanks to hapten inhibition.

Anaphylaxis↗

Safety of intraperitoneal 32% dextran 70 as an antiadhesion adjuvant.

The records of 139 consecutive patients who underwent major gynecologic abdominal surgery in which 32% dextran 70 was used as an antiadhesion adjuvant were carefully reviewed for the presence or absence of dextran-related complications. Eleven patients (8.0%) were thought to have dextran-related complications, including postoperative ileus (2.9%), pleural effusion (2.2%), allergic reactions (1.4%), wound infection (1.4%) and labial swelling (0.7%). The mean amount of dextran used was 183 mL. The study indicated that dextran can be used in moderate amounts when instilled intraperitoneally and has an acceptably low rate of complications. Since dextran is used often in spite of scanty evidence of its effectiveness as an antiadhesion adjuvant, understanding its safety and potential complications is especially important.

Adjuvants, Pharmaceutic↗

The effect of iso-oncotic plasma substitutes: gelatine, dextran 40 (50 g/l) and the effect of Ringer's lactate on the plasma volume in healthy subjects.

82 healthy subjects undergoing Extra-corporeal Shock Wave Lithotripsy (ESWL) under epidural anesthesia were given 1000 ml of either gelatine (Geloplasme), dextran 40, 50 g/l (Isodex) or Ringer's lactate. The purpose of the study was to determine the efficacy of the three described solutions in respect to blood volume changes. A clear differentiation is only possible under absolutely defined physiological conditions and therefore in contrast to other studies, none of these patients was suffering from any shock syndrome or had any blood loss, so no capillary leakage or transcapillary refill problem was present. Plasma volume (PV), colloid oncotic pressure (COP) and hematocrit (Hct) were measured before and 15, 120 and 240 min. after infusion. PV increased both in the gelatine and dextran groups with a higher initial increase in the dextran group. COP increased after 15 min. and Hct decreased after 15 min. in the gelatine and dextran groups. With regard to absolute contraindications this study suggests that dextran 40 can be recommended as plasma substitute due to its higher initial increase in PV, its moderate duration of effect and its low incidence of anaphylactic reaction after a preceding infusion of 20 ml dextran Mw 1000 (Promiten).

Adult↗

Effect of dextran infusion on the phagocytic and metabolic functions of the reticuloendothelial system in man.

The reticuloendothelial system (RES) is part of the host defence and consequently plays an important role in shock and trauma, conditions often requiring volume replacement. Experimental studies have shown that the functions of the RES are hampered by plasma substitutes such as gelatin, starch and dextran. In this study six patients undergoing elective cholecystectomy were given 500 ml dextran just before the operation. At the end of the operation the phagocytic and metabolic functions were tested with microaggregated human serum albumin labelled with I125. The results indicate that there is a significant impairment of the phagocytic activitity of the RES in patients given dextran compared to controls not given dextran but saline. The metabolic activity was not significantly affected by dextran, however, suggesting that moderate dosage of dextran is not of great disadvantage to patients undergoing major surgery.

Cholecystectomy↗

Effect of dextran on factor VIII and thrombus stability in humans. Significance of varying infusion rates.

The in vivo effect of dextran 70 on Factor VIII (antihemophilic factor) and thrombus stability has been studied in human volunteers after infusion at various rates. Varying the infusion time of dextran from 15 minutes to 2 hours did not result in any differences in the concentrations of dextran, fibrinogen and hematocrit, thus indicating similar degrees of hemodilution. Nor were any differences found in the effect of dextran on Factor VIII and thrombus stability. With regard to the antithrombotic function of dextran by hemodilution and effect on Factor VIII, there does not seem to be any advantage in giving dextran rapidly. This information could be of value in the treatment of elderly patients, for whom thrombosis prophylaxis is especially indicated and whose tolerance for hypervolemia is limited.

Clinical Trials as Topic↗

[Coagulation-physiological studies on the prevention of thromboembolism with dextran 60. II. Changes in coagulation and fibrinolysis].

The postoperative behavior of different parameters of coagulation and fibrinolysis have been studied in three groups of 20 patients each. Group A got only 4-hydroxycumarin, group B 500 ml Dextran 60 intraoperatively in addition to that, group C 500 ml Dextran 60 during surgery and on the 1., 2., 4., 7. and 10. postoperative day. The results show that the hypercoagulability which occurs immediately after surgery can be prevented by infusion of Dextran 60. On the other hand there is no evidence that Dextran 60 may cause a consumptive coagulability. There is only little influence on fibrinolysis, so that no defect of haemostasis can be expected. So it is possible to use Dextran 60 both for bridging over the phase of early embolism after surgery until the change to other anticoagulants and as a substance which can be applicated for a longer period of time in prophylaxis of thromboembolism. It is referred to the additional properties of Dextran 60 in prevention of thrombosis due to reduction of blood viscosity and improvement of microcirculation.

4-Hydroxycoumarins↗

[The influence of low molecular dextrans on the survival of fibrinogen and platelets in rabbits (author's transl)].

Dextrans have various biological effects dependent on their molecular size. The thromboprophylactic effect of low molecular dextrans (LMDx) is due to a multifactorial mechanism leading to some coagulative changes without bleeding risk. Whereas some properties of platelets and plasma fibrinogen are modified by LMDx, there is no information about its influence on the survival times and catabolic rates which have been investigated in this study using 125I-fibrinogen and 75Se-selenomethionine for the in vivolabelling of the platelets. Both dextran 40 and 60 were found to cause a significant reduction of plasma fibrinogen level, platelet counts, and haematocrit during the first 3 hours after dextran infusion. the changes in TEG (prolongation of r+k-time, decrease in thrombus elasticity) were normalised 12 hours after the end of the dextran application. The survival times and catabolic rates of 125 I-fibrinogen and in vivo-labelled platelets, however, were not changed by dextran 40 or 60. But both LMDx seemed to accelerate the incorporation of the radioactive methionine into the platelets. this phenomenon might be explained by the physico-chemical properties of LMDx which guarantee the antihrombotic effects too.

Animals↗

Measurement and control of quality determining properties of clinical dextrans.

For plasma substitutes a main requirement is that they give plasma volume expansion. For dextran this property has been shown to be molecular weight dependent. The magnitude and duration of the volume effect, and the magnitude and rate of the excretion of dextrans have been carefully studied with regard to the correlation with molecular weight. Other clinically important effects like flow promotion and disaggregation of erythrocytes also have shown correlation with molecular weight. The measurement and control of the molecular weight distribution (MWD) of clinical dextrans thus is an important quality measure. The tolerance limits must be so set that a clinically relevant discriminating effect is obtained. In most of the current official monographs methods give only average figures of the MWDs or of broad fractions of the MWDs. In some cases these figures are not even molecular weight figures but viscosity figures. In the 1960's gel permeation chromatography (GPC) methods were developed for quality control of dextran. These methods are now suggested and considered for some pharmacopoeias, and are already introduced into one, namely the Nordic Pharmacopoeia. With these methods information of the total MWD is obtained. The proportion of dextran in a desirable molecular weight range can be directly seen, and presence of dextran with undesirable molecular weight can be revealed.

Dextrans↗

[Changes in the colloid-osmotic pressure by a foreign colloid (dextran 70)].

In 55 patients undergoing elective surgery (general or urological) the colloid osmotic pressure (COP) of serum was followed up until the sixth postoperative day. The patients were divided into two groups, one receiving intra- and postoperative administration of dextran 70 and the other as a control group with no dextran. COP was measured at an artificial membrane (M = 10000) by a transducer; at the same time the concentrations of total protein, albumin and globulin were determined in order to calculate the COP by the formula of Keys. The dextran group and control group showed no difference in the measured COP. This variable reached the lowest value (which was not below 20 mm Hg) on the first postoperative day. The control patients showed close agreement of measured and calculated COP, while the calculated COP of dextran patients was significantly lower than the measured COP until the sixth postoperative day; the artificial membrane thus registered the action of dextran for this length of time. After each dextran infusion the serum proteins fell to a lower level than in the control group. Three possible explanations are discussed: an increase in intravascular volume, accelerated passage of macromolecules through the capillary wall, and a decrease in albumin synthesis.

Aged↗

Effects of exogenous soluble dextrans on insoluble glucan synthesis by Streptococcus mutans glucosyltransferase.

Production of water-insoluble glucan (ISG) from sucrose by cell-free Streptococcus mutans AHT glucosyltransferase (GTF) first rapidly increased, and then sharply declined, as the amounts of water-soluble Dextrans T20 approximately T500 present, were increased. The decline of ISG synthesis was accompanied by an increased synthesis of the water-soluble fraction (SG). Prolonged incubation, however, induced enhanced synthesis of ISG even at higher dextran concentrations. The concentration of dextran required to stimulate or suppress ISG synthesis depended on the amounts of GTF used, but the extent of the stimulation was almost identical for the same GTF/dextran ratio. Thus, ISG synthesis is stimulated by the presence of dextrans at relatively low concentrations, but retarded at higher concentrations by being shifted to SG synthesis. ISG produced in the presence of dextrans contained higher proportions of alpha-1,6 glucosidic linkage and lower molecular size fractions, and possessed lower viscosity. These ISG products did not exhibit the coalescence of two component fibrils as observed with control ISG. These changes combined may contribute to the reduction of ISG-dependent adherence to glass of S. mutans cells by the presence of soluble dextrans, irrespective of their molecular size and concentration.

Adhesiveness↗

[The problem of dextran intolerance and its specific prevention with hapten inhibition. A part of the history of applied immunology].

Dextrans are used in clinical medicine since more than 35 years. One of the main problems of dextran application are severe incompatibility reactions of the anaphylactoid type. Lethal cases have been reported. In the early fifties antibodies against high molecular weight dextrans have been described in patients with incompatibility reactions as well as in normals. By the introduction of new dextrans (produced by B. Leuconostoc mesenteroides B 512) with lower molecular weight and less branching newer solutions were developed without immunogenicity. When, in the early seventies, cases of severe incompatibility reactions to those dextrans were reported, nonimmunological mechanisms were discussed as e.g. direct mediator release--as in the model of rat dextran hypersensitivity--or direct complement activation via the alternative pathway.

Allergy and Immunology↗

Dilute iron dextran formulation for addition to parenteral nutrient solutions.

The stability of dilute iron dextran formulations and of one formulation in parenteral nutrient solutions was studied. Seven formulations for dilute (50 mg/dl) iron dextran solutions and four parenteral nutrient solutions containing 100 mg/liter of iron dextran were prepared. Total iron and free ferrous ion content of the preparations were measured for: (1) the dilute solutions at monthly intervals after up to three months of storage at room temperature and under refrigeration and (2) the parenteral nutrient solutions after 18 hours of storage at room temperature. Four of the seven dilute solutions were stable after two months of storage. The easiest-to-prepare dilute solution (iron dextran, benzyl alcohol, and sterile water for injection) was stable for three months; stability was greater when refrigerated. Iron dextran was stable in the four parenteral nutrient solutions after 18 hours of room-temperature storage. The study suggests that addition of recommended daily doses of iron dextran to parenteral nutrient solutions creates no stability problems; however, further study of the effects of temperature, pH, light, and storage time are recommended.

Drug Compounding↗

Anterior segment permeability to fluorescein-labeled dextrans in the rat.

Permeability of the anterior segment of adult Wistar-Furth rats to fluorescein-labeled dextrans (FITC-dextrans) was evaluated by fluorescein angiography following intravenous injection of 0.2 ml of a 33% FITC-dextran solution. Permeation of each fluorescent compound into the anterior chamber was evaluated by (1) initial appearance of fluorescence in iris vessels, (2) the appearance of fluorescence at the pupil, (3) contrast between the iris vessels and their surroundings, and (4) disappearance of FITC-dextrans from the iris blood column. Permeability of FITC-dex 3 (molecular weight, 3000; effective diffusion radius, 12 A) was similar to that of sodium fluorescein in that both entered the aqueous rapidly and showed diffuse aqueous fluorescence within 3 min. As the molecular weight of the FITC-dextrans increased (m.w. of 20,000, 40,000, 70,000, and 150,000 were used), the FITC-dextrans exhibited decreased aqueous permeation, and iris vessel contrast persisted. For FITC-dex 150 (m.w. 150,000; 85 A) no fluorescence was visible in the pupil at times as long as 1 hr. Since these fluorescent compounds exhibit aqueous permeability properties based upon molecular size and thus are similar to blood proteins, they should be useful for in vivo and in vitro quantitative study of the blood-aqueous barrier in animals.

Animals↗

Immunologic studies of anaphylaxis to iron dextran in patients on renal dialysis.

Systemic reactions resembling anaphylaxis have occurred after intravenous (IV) iron-dextran administration, a treatment modality that has acquired increased acceptance following the use of erythropoietin for the anemia of patients with chronic renal diseases. Three such patients sustained anaphylactoid reactions immediately after receiving IV test doses of iron-dextran which were their only known exposures. In an effort to determine the mechanism of their reactions, we applied tests for (1) basophil degranulation by iron-dextran, basophil histamine release; (2) a type I anaphylactic reaction, specific IgE antibodies; and (3) an immune complex activation, specific IgG antibodies against iron-dextran. Six other patients with renal diseases served as controls, three of whom had tolerated IV iron-dextran, and three without known exposure. One patient only had any test abnormalities. Her initial positive basophil histamine release and specific IgG antibodies reversed and declined respectively at a 4-month follow-up study. She had developed anaphylaxis, and her studies had been performed at a time after anaphylaxis earlier than the other two. The mechanisms of iron-dextran anaphylaxis may be multiple and not be detectable several months after the incident. Prospective studies will probably be required for a predictive test to be developed.

Adult↗

[Paracentesis associated to dextran-70 in the treatment of ascites in patients with chronic liver diseases: a randomized therapeutic study].

The treatment of ascites of large volume in chronic liver disease patients was evaluated in the present study. We compared diuretics with paracentesis and an infusion of Dextran-70. Therapeutic efficacy, complications and length of hospital stay were the variables studied. Of the 38 patients, 20 were selected randomly. They were evaluated using clinical, laboratory and/or histological criteria: 10 patients in the paracentesis group with Dextran-70 and 10 in the diuretic group. The groups were similar with respect to age, diagnosis and Child-Pugh classification. However, there was a greater number of males in the paracentesis group with Dextran-70. In each paracentesis, an average of 9.41 liters (4.5 to 14.1) of ascitic fluid was collected. The average hospitalization period in the paracentesis group with Dextran-70 was 10.5 days (8-14), significantly less when compared to the diuretic group: 24.4 days (14-48). In the diuretic group one patient presented complications such as hyperkalemia, increased urea and creatinine levels, while in the paracentesis group with Dextran-70 one patient presented a temperature above 38 degrees C during treatment. The results suggest that paracentesis associated with Dextran-70 could be a therapeutic alternative for chronic liver disease patients with ascites in our population. It was effective; it had no significant side effects; it reduced the length of hospital stay and therefore should decrease the cost and the risk of complications in patients requiring prolonged hospitalization periods.

Ascites↗

Permanent hepatic artery embolization with dextran microspheres in 131 patients with unresectable hepatocellular carcinoma.

One hundred thirty-one patients with hepatocellular carcinoma were subjected to permanent hepatic artery embolization with dextran microspheres (G-25, 50-150 mu). Dextran hepatic artery embolization is indicated for massive, nodular or multinodular hepatocellular carcinoma with total bilirubin less than 3 mg/dl, serum albumin greater than 3.0 g/dl, tumor involvement area less than 50% or without involvement of the main portal vein. Following hepatic angiography a catheter was inserted superselectively into the hepatic artery feeding the tumor. Adriamycin (60-80 mg) or cisplatin (60-100 mg) was infused immediately before embolization. Under fluoroscopic guidance, 0.3-0.5 g of dextran microsphere embolizer permeated with 10 mg of mitomycin C was infused into the feeding artery through the catheter. Dextran microspheres caused marked homogeneous and distal micro-arterial embolization, especially in the arteriole with a caliber of about 100 mu. Dextran microspheres were not resorbed in a period of 16 weeks in humans, thus reducing or preventing the formation of intrahepatic and extrahepatic collaterals after hepatic artery embolization. Dextran hepatic artery embolization was very effective for not only main tumor but also daughter foci or metastatic nodules, as was confirmed histologically in 8 cases. The 1-year, 2-year and 3-year survival rates were 57.0%, 31.4% and 24.2% respectively.

Adult↗

Nature of interaction of dextran sulfate with lecithin dispersions and lysolecithin micelles.

Lecithin and lecithin/cholesterol dispersions as well as lysolecithin micelles were used to provide basic information on the mechanism of the interaction of zwitterionic phospholipids with dextran sulfate. The addition of dextran sulfate to lecithin dispersions or lysolecithin micelles in the presence of Ca2+ produced insoluble complexes. At each Ca2+ concentration, the amount of insoluble complex formed was maximal at the equivalence dextran sulfate/phospholipid weight ratio. An increase in CaCl2 concentration up to 10 mM progressively increased the equivalence ratios for the phospholipids. Further increase in Ca2+ concentration did not influence the equivalence ratio for maximal complex formation. The conversion of lecithin dispersions into insoluble complexes was very effective even at low Ca2+ concentrations. Approximately 70% of the lecithin was converted to the insoluble complex at CaCl2 concentrations as low as 0.5 mM and the complete conversion was observed at CaCl2 concentrations above 2.5 mM. In the presence of cholesterol, the precipitation curve for insoluble complex formation became broader than that of lecithin alone, indicating the enhancing effect of cholesterol on the insoluble complex formation both below and above the equivalence ratio. The stoichiometry of the interaction of the zwitterionic phospholipids with dextran sulfate inthe presence of calcium was determined using lysolecithin micelles. At the CaCl2 concentrations above 20 mM, the insoluble complex possessed a ratio of lysolecithin/calcium/sulfate group of approximately 2/1/3 (mol/mol/mol). It appears that the formation of the insoluble complex of lecithin or lysolecithin with dextran sulfate represents the mutually enhancing interactions involving both positive and negative charges of the zwitterionic phospholipids. These are the direct electro static interaction between the phospholipid choline nitrogen and the sulfate groups of dextran sulfate and the calcium cross-linking of the phosphate groups to the sulfate groups or to the phosphate groups of neighboring phospholipids.

Binding Sites↗