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Independence of reciprocal attachment sites on denatured collagen and fibronectin from antigenic sites, and binding of gelatin-based plasma substitutes to plasma fibronectin.

Fibronectin and denatured collagen possess attachment sites for each other and, in addition, antigenic sites reacting with the respective antibodies. Using an enzyme linked immunosorbent assay it was shown that attachment sites and antigenic sites on fibronectin and on collagen reacted independently of each other. Gelatin-based plasma substitutes blocked the binding of fibronectin to denatured collagen thus showing that attachment sites for fibronectin are preserved in the gelatin preparations used for manufacturing these plasma substitutes. Antigenic sites, in contrast, were destroyed during the manufacturing process as shown with antibodies to denatured collagen raised in guinea-pigs. It is concluded that complex formation of gelatin-based plasma substitutes with plasma fibronectin may occur upon infusion of such plasma substitutes but that formation of antigen/antibody complexes in vivo is unlikely.

Animals↗

Effects of solvent/detergent-treated plasma and fresh-frozen plasma on haemostasis and fibrinolysis in complex coagulopathy following open-heart surgery.

BACKGROUND AND OBJECTIVES: Solvent/detergent-treated plasma (SDP) contains markedly lower protein S (PS) and plasmin inhibitor (PI) activity than standard fresh-frozen plasma (FFP). It has also been reported that SDP contains no alpha(1)-antitrypsin. Despite the lack of clinical data, it is suspected that SDP may be less effective than FFP in the treatment of complex coagulopathies. We therefore conducted a prospective trial to study the impact of SDP and FFP on haemostasis and fibrinolysis in complex coagulopathy after open-heart surgery. MATERIALS AND METHODS: Patients received either 600 ml of SDP (n = 36) or 600 ml of FFP (n = 31) at an infusion rate of 30 ml/min. The following parameters were measured before treatment and 60 min after termination of plasma infusion: prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, factor VIII, antithrombin, protein C (PC), free PS and PS activity, prothrombin fragments F1+2 (F1+2), D-dimers (DD), fibrinogen degradation products (FDP), plasmin-plasmin inhibitor complexes (PPI), plasminogen, PI and alpha(1)-antitrypsin. RESULTS: The rise in fibrinogen, factor VIII, antithrombin, PC, free PS, alpha(1)-antitrypsin and plasminogen, and the decrease in PT and APTT, did not significantly differ between the two study arms. However, PS activity did not increase after SDP infusion but did show a significant elevation after infusion with FFP. PI declined significantly after SDP and remained uninfluenced by FFP. Neither SDP nor FFP had any significant influence on F1+2, DD or FDP. However, a significant decrease in PPI levels caused by both types of plasma indicated a reduction in hyperfibrinolysis. Clinical haemostasis evaluation revealed no significant difference between the two treatment regimens. No adverse reactions were observed. CONCLUSION: With the exception of PS and PI, SDP and FFP improved haemostasis and fibrinolysis to a similar degree. The clinical significance of these findings has to be determined in patients with severe acquired PS and PI deficiency requiring plasma transfusions.

Adult↗

Influence of prolonged physical exercise on plasma volume, plasma proteins, electrolytes, and fluid-regulating hormones.

Fluid-regulating hormones [arginine vasopressin (AVP) and aldosterone] as well as electrolytes, plasma volume (PV), and plasma proteins were studied in 16 well-trained male amateur runners (mean age 31.8 years) before t0), immediately after (t1), and 60 min (t2) and 22 h (t3) after a marathon run. Immediately after the run PV was significantly decreased by 12.1%, whereas the concentration of plasma proteins increased by 13.9%, sodium by 5.8 mMol.l-1, and potassium by 0.58 mMol.l-1, respectively. Aldosterone increased by 1089 pg/ml and AVP by 9.0 pg/ml. PV was significantly increased 22 h after the run by 10.6% (P less than 0.001) and plasma proteins were increased by 1.0% (P greater than 0.05), whereas aldosterone and AVP as well as electrolytes returned to control values. At t1, and particularly at t2 and t3, the total plasma protein concentration increased much more than could have been expected from changes of PV. It is suggested that this phenomenon was caused by an influx of proteins into the vascular space. This might also be the reason for the expanded PV especially in the longer recovery period at t3. The volume-regulating hormones (AVP and aldosterone) may play an important role during and immediately after the run but not in the longer recovery period (t2 and t3).

Adolescent↗

Relationship of vitamin A and vitamin E intake to fasting plasma retinol, retinol-binding protein, retinyl esters, carotene, alpha-tocopherol, and cholesterol among elderly people and young adults: increased plasma retinyl esters among vitamin A-supplement users.

We studied the relationships of supplemental and total vitamin A and supplemental vitamin E intake with fasting plasma biochemical indicators of vitamin A and vitamin E nutritional status among 562 healthy elderly people (aged 60-98 y) and 194 healthy young adult (aged 19-59 y) volunteers. All subjects were nonsmokers. For the young adults, plasma retinol was significantly greater in males than in females (p less than 0.01); retinol was not related to supplemental vitamin A intake for either group. Fasting plasma retinyl esters demonstrated a significant increase with vitamin A supplement use. For supplemental vitamin A intakes of 5001-10,000 IU/d, a 2.5-fold increase over nonusers in fasting plasma retinyl esters was observed for elderly people (p less than 0.05) and a 1.5-fold increase for young adults (p greater than 0.20). For elderly people, greater fasting plasma retinyl esters were associated with long-term vitamin A supplement use (greater than 5 y) and biochemical evidence of liver damage. Elderly people who take vitamin A supplements may be at increased risk for vitamin A overload.

Aged↗

Passive immunotherapy in AIDS: a randomized trial of serial human immunodeficiency virus-positive transfusions of plasma rich in p24 antibodies versus transfusions of seronegative plasma.

To assess the place of passive immunotherapy in the treatment of AIDS, a randomized study was conducted that evaluated the safety and short-term efficacy of serial transfusions of human immunodeficiency virus type 1 (HIV-1) seropositive plasma in 18 patients. Heat-inactivated anti-HIV antibody-rich plasma was compared with seronegative fresh-frozen seronegative plasma given in addition to zidovudine and other conventional prophylactic treatments. Seven transfusions every 2 weeks of immune plasma significantly reduced (2 vs. 8, P = .016) the number of opportunistic infections. Antigenemia became undetectable. When transfusions were stopped, positive p24 antigenemia returned at a level higher than before treatment and was correlated with a severe clinical deterioration, suggesting a rebound effect. This trial suggests that passive immunotherapy is promising in AIDS treatment. It confirms also that plasma donation does not affect donors' CD4 cell count over a 1-year period. In patients with severe immunodeficiency, special attention should be paid to withdrawal of an effective therapy as virologic relapse may be explosive and poorly tolerated.

Acquired Immunodeficiency Syndrome↗

Human plasma all-trans-, 13-cis- and 13-cis-4-oxoretinoic acid profiles during subchronic vitamin A supplementation: comparison to retinol and retinyl ester plasma levels.

Plasma concentrations of retinyl esters, retinol, retinol-binding protein and the polar retinol metabolites all-trans-retinoic acid, 13-cis-retinoic acid, all-trans-4-oxoretinoic acid and 13-cis-4-oxoretinoic acid were measured for six male volunteers who received 0.46 mg retinyl palmitate per kilogram body weight as oily drops (equivalent to 0.25 mg retinol per kilogram body weight) once daily over a 20-d period. Retinol and retinol-binding protein levels remained virtually constant throughout the study. Following absorption of vitamin A, retinyl esters as well as all-trans-retinoic acid and 13-cis-retinoic acid were transiently increased in plasma. 13-cis-4-Oxoretinoic acid increased gradually to a steady state level present on d 10 or 20. All-trans-4-oxoretinoic acid was not detected in plasma of the volunteers, with the exception of one on d 10 of the study. Plasma pharmacokinetic profiles of retinyl esters and polar metabolites of retinol displayed great interindividual differences (peak concentrations, time to peak, area-under-the-concentration-time curve values) among the volunteers. Because of the relatively high and consistent steady state concentrations of plasma 13-cis-4-oxoretinoic acid, we suggest that this compound be further investigated as a biochemical marker of vitamin A uptake in humans.

Administration, Oral↗

Effect of high dose spironolactone and chlorthalidone in essential hypertension: relation to plasma renin activity and plasma volume.

The effect on blood pressure of high (400 mg/day-S400) and moderate dose (200 mg/day-S200) spironolactone and chlorthalidone (100 mg/day-C100), given in a random double-blind manner was related to plasma renin activity and plasma volume in 38 essential hypertensives. The fall in pressure from a control of 154/103 mm Hg was essentially the same after four weeks of each drug--S400 deltaBP 24/13 mm, S200 18/9 mm, C100 17/12 mm (all P less than 0-001). Twelve of 37 patients (32%) had low initial renin, but this appeared as responsive to the chlorthalidone stimulus as that of the normal renin group. The antihypertensive effect of all regimens was unrelated to plasma renin activity. Plasma volume was significantly lowered at the end of each treatment period, but the decline could not be correlated with blood pressure effects. Patients with initially low plasma volume were more likely to respond to S400 (r = 0-545, P less than 0-001), whereas the antihypertensive effect of the S200 and C100 regimens was independent of this variable.

Adult↗

Plasma volumes, blood volumes, and plasma protein concentrations after moderate haemodilution with fluosol-DA or normal saline in the rat.

Plasma volumes, blood volumes, and plasma total protein, albumin, and bilirubin concentrations have been determined in rats for 72 h following 20 or 40 mL kg-1 haemodilution with Fluosol-DA or 0.9% NaCl. Haemodilution with 20 mL kg-1 of either haemodiluent had no influence on the measured values. Plasma and blood volumes did not change after Fluosol-DA haemodilution at 40 mL kg-1, but albumin and bilirubin concentrations were decreased for 72 h. Only bilirubin concentrations were decreased for 72 h following haemodilution with 40 mL kg-1 of 0.9% NaCl. It was concluded that changes in a drug's plasma protein binding, and not the plasma or blood volume, are responsible for the reported alterations in a drug's apparent volume of distribution after haemodilution.

Albumins↗

Plasma exchange treatment of peripheral neuropathy associated with plasma cell dyscrasia.

Plasma exchange was used to treat 10 patients with polyneuropathy and a monoclonal antibody (plasma cell dyscrasia). Six patients had improvement of the neuropathy, while three patients had stabilisation of the neuropathy during plasma exchange. The patients who improved maintained a 64% or greater decrease in the monoclonal antibody between exchanges. Patients with axonal polyneuropathy as well as patients with demyelinating polyneuropathy recovered some neurologic function. With cessation of plasma exchanges, the monoclonal antibody titre approached pre-treatment levels and the neuropathy progressed. Plasma exchange was effective in rapidly lowering the level of monoclonal antibody and allowing for some recovery of neurologic function.

Adult↗

Significance of plasma skimming and plasma volume expansion.

The organs associated with plasma volume expansion, i.e., the red bone marrow, the enlarged spleen, and the uteroplacental complex, are arteriovenous shunts with an interposed sinusoidal stroma able to skim off plasma-rich blood. In the spleen, plasma separation is an integral part of the hemoconcentration. In the red bone marrow, plasma skimming might provide a washout mechanism for the many newly formed erythrocytes and platelets from the sinusoids to the peripheral blood circulation. In the uteroplacental complex, skimming of plasma-rich blood is beneficial in increasing blood flow in the myometrium, kidneys, and skeletal musculature. The hypervolemic status with anemia will simulate a negative iron balance, which speeds up the absorption of iron. Thus a conceptual unit seems to exist in which rheological factors influence such functions as transport of newly formed blood cells into the circulation (in the red bone marrow), hemoconcentration (in the spleen), and iron balance during pregnancy (in the uteroplacental complex).

Bone Marrow↗

Heat acclimation improves regulation of plasma volume and plasma Na(+) content during exercise in horses.

This study determined the plasma volume (PV) and ion responses to heat acclimation and exercise in six trained Thoroughbred horses during 21 days of exposure to heat and humidity (33 degrees C, 83% relative humidity) for 4 h/day. During the 2nd h on days 0, 3, 7, 14, and 21, horses performed a standardized treadmill test, running at 50% of peak O(2) uptake until pulmonary artery temperature reached 41.5 degrees C. Heat acclimation resulted in an increase in PV from 21.3 +/- 1.1 liters on day 0 to 24.3 +/- 1.0 liters on day 14, returning to 22.6 +/- 0.9 liters on day 21. The corresponding total plasma protein contents were 1,273 +/- 53, 1,455 +/- 81, and 1,377 +/- 57 g, respectively, and increases in total plasma Na(+) plus Cl(-) content were 5,145 +/- 126, 5,749 +/- 146, and 5,394 +/- 114 mmol, respectively. Thus changes in PV were accompanied by direct changes in plasma protein and osmolyte contents. With exercise on day 0, PV decreased by 7.1 +/- 0.7% at 5 min of exercise and remained decreased (-6.7 +/- 1.3%) at 5 min of recovery. By day 21, PV decreased significantly less than on day 0 (by 5.2 +/- 0.9% at 5 min of exercise), was decreased by only 2.0 +/- 1.6% at 5 min of recovery, and was fully restored at 15 min of recovery. Plasma Na(+) concentration increased 3 meq/l during the first 5 min of exercise and was normalized by 5 min of recovery on day 0 and by end exercise on day 21. It is concluded that improved ability to regulate PV during exercise in response to heat acclimatization is associated with an increased PV and an improved conservation of Na(+).

Acclimatization↗

[Important laboratory parameters of deep frozen coagulation active fresh plasma and virus inactivated lyophilized pool plasma].

Fresh Frozen Plasma is the most important therapeutic agent in acquired coagulation disorders. We investigated the quality of a new virus-inactivated lyophilisated human pool-plasma (VFL) and conventional fresh frozen plasma (FFP). In VFL we found a significantly reduced coagulation activity, a significantly higher pH-value, a highly significant rise of heparin values and a significantly lower number of thrombocytes. Electrolytes, protein levels and complement activity showed no significant difference. In conclusion, this virus-inactivated lyophilisated human pool plasma does not seem to be susceptible to therapy coagulation disorders like the conventional fresh frozen plasma.

Antiviral Agents↗

Measurement of the pregnancy-associated proteins, placental protein 14 and pregnancy-associated plasma protein A in human seminal plasma.

The pregnancy-associated and placental proteins PP14 and PAPP-A have been measured in human seminal plasma from normal men. PP14 was a significant protein constituent in most seminal plasma samples; sometimes comprising over 2.5% of the total protein content. The concentration of PP14 in seminal plasma from men with oligospermia was in the reference range of this protein derived from values measured in normal men. However, about 14% of samples from vasectomized subjects contained concentrations of PP14 less than normal. It was found that the concentration of PAPP-A in seminal plasma from vasectomized men and men with oligospermia also fell within the reference range for this protein. However, the concentration of PAPP-A in seminal plasma was significantly higher in those subjects whose sperm motility was above 60% than in those with a lower percentage motility, suggesting a possible role of this protein in sperm function.

Glycodelin↗

[Preoperative plasma exchange in treatment of plasma-related coagulation disorders before liver transplantation].

PATIENTS AND METHODS: Seventy-two consecutive patients undergoing orthotopic liver transplantation at the Department of Surgery I, University of Vienna Medical School (OLT nos. 1 to 72), were evaluated. Their mean age was 47 years (range: 18-63 years). The indications for liver transplantation are listed in Table 1. All transplant procedures were performed without using a bypass technique. The intraoperative management and surgical procedure have been described elsewhere [7]. Patients were categorized in two groups, each of which was divided in two subgroups. Group I consisted of 18 patients transplanted before the introduction of preoperative plasma exchange. These were retrospectively allocated to two subgroups on basis of their preoperative prothrombin times (PT): A (n = 9): preoperative PT less than 40%; B (n = 9): preoperative PT greater than 40%. The two subgroups of group 2, which contained 54 patients, were compared on a prospective basis: C (n = 32): preoperative PT above 40%; D (n = 22): PT on admission below 40%, preoperative plasma exchange. Comparison of the two subgroups was based on the following parameters: (1) pre-exchange PT (subgroup D); (2) preoperative PT (= PT post-plasma exchange in subgroup D; (3) intraoperative infusion volumes (balanced electrolyte solutions and human albumin to maintain an intravascular colloid osmotic pressure greater than 16 mm Hg); (4) transfusion volumes (whole blood stored for no more than 72 h or packed red cells and fresh plasma, as available; and (5) intraoperative sodium bicarbonate requirements to maintain an arterial pH greater than 7.20. RESULTS: (Table 2) . Prothrombin time (PT): Group 1: Patients in subgroup A had a mean preoperative PT of 34% (range: 15%-40%). This was significantly lower than in subgroup B (74%; 52%-100%; P less than 0.001). Group 2: The pre-exchange mean PT in subgroup D was 27% (12%-39%) vs. 68% in subgroup C (45%-104%), the difference being highly significant (P less than 0.0001). In patients in subgroup D a mean plasma volume of 3638 ml was exchanged by plasmapheresis. This resulted in a significant increase in PT to 55% (Table 3). As a result, the preoperative post-exchange PT in subgroup D was slightly but significantly (P less than 0.005) less than in subgroup C. Transfusion volumes: Group 1: Patients in subgroup A needed significantly more blood units than those in subgroup B (55.3 units [19-110] vs. 18.7 [3-33]).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

Interleukin-1 beta in human plasma: optimization of blood collection, plasma extraction, and radioimmunoassay methods.

Current immunoassays for interleukin-1 beta (IL-1 beta) are effective for analyzing fluids derived from cultured cells. However, IL-1 beta determinations in human plasma or serum samples are technically complicated by higher protein and lipid concentrations, physicochemical differences which exist between samples from healthy subjects and those experiencing acute phase responses, and by the fact that IL-1 beta can be produced and degraded in the blood collection tube after the sample is drawn. A simple chloroform extraction process has been developed which eliminates several of the interfering factors from plasma samples and increases the amount of IL-1 beta detected by radioimmunoassay and lymphocyte activation assay. In the radioimmunoassay, rabbit sera was found to influence the accuracy and variability of plasma measurements. Improvements in radioimmunoassay reagents and methods are reported which reduce this influence. Finally, different concentrations of IL-1 beta were measured depending on whether serum or plasma was tested. We propose that plasma samples collected with EDTA and aprotinin provide a better determination of free circulating IL-1 beta in vivo than serum samples, which may contain IL-1 beta secreted from blood leukocytes during the clotting process.

Acute-Phase Reaction↗

The use of human plasmas and plasma-depleted blood fractions in the in vitro cultivation of the malaria parasite Plasmodium falciparum.

The decreasing availability of whole blood and serum from blood banks led us to investigate the suitability of untreated and heat-treated human plasma, as well as of plasma-depleted blood fractions, for routine culturing of P. falciparum. The practical problems of using plasma instead of serum were addressed and the effect of storage conditions tested. We conclude that plasma is a convenient and effective substitute for serum, and that plasma-depleted blood fractions are as receptive to parasite infection as unprocessed blood.

Animals↗

Current status of membrane plasma separation and plasma filtration techniques.

Blood and plasma processing by membranes was introduced into clinical medicine in 1979. In the meantime, membrane plasma separation (plasmapheresis) has become very satisfactory and is now a routine therapeutic procedure in many apheresis centers. Plasma fractionation by membranes (plasma filtration or cascade filtration) for unselective removal of high molecular weight pathogens from the separated plasma is technically possible but its routine clinical application is still limited to a few diseases with at least IgM-sized target proteins. The separation of IgG from albumin needed to treat many autoimmune diseases requires further development of both the membranes and the filtration technology.

Filtration↗

Bone marrow aspirate immunofluorescent and bone marrow biopsy immunoperoxidase staining of plasma cells in histologically occult plasma cell proliferative marrow disorders.

Immunofluorescent staining (immunofluorescence bone marrow aspirate) and immunoperoxidase staining (immunoperoxidase bone marrow biopsy) were compared in 26 patients with plasma cell dyscrasia and less than 10% marrow plasma cells. Their clinical diagnoses included monoclonal gammopathy of undetermined significance (13 patients), treated multiple myeloma (four patients), multiple myeloma with less than 10% marrow plasma cells (two patients), primary systemic amyloidosis (two patients), monoclonal gammopathy of undetermined significance with neuropathy (two patients), angiofollicular lymph node hyperplasia (two patients, all with the POEMS [polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes] syndrome), and primary (amyloidosis) amyloid neuropathy (one patient). The percentage of plasma cells was greater than 5% in 23% of patients and less than or equal to 5% in 77% of patients. With immunofluorescence bone marrow aspirate and immunoperoxidase bone marrow biopsy, light-chain restriction was demonstrated in 84% of all cases and accurately determined in 96% of all cases as shown by serum and urine paraprotein analysis or tissue amyloid typing. Monoclonal populations of plasma cells can be readily identified with immunofluorescence bone marrow aspirate and immunoperoxidase bone marrow biopsy in most patients with paraproteins and marrow plasmacytoses not diagnostic of multiple myeloma.

Adult↗