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PubMed1995

Response of plasma ASP to a prolonged fast.

OBJECTIVE: To determine the changes in the plasma level of acylation stimulating protein (ASP) during a one month total fast in female subjects with marked obesity. DESIGN: Patients with marked obesity underwent a month total fast, before, during (2 weeks), and at the end of which, a variety of relevant metabolic parameters were measured. SETTING: A metabolic unit of a teaching hospital. SUBJECTS: 10 women with marked obesity were studied and the results compared with those in 16 age-matched controls. MAIN OUTCOME MEASURES: Plasma ASP, lipoprotein lipids, apoB, free fatty acid, and ketone levels. RESULTS: At baseline, fasting levels of ASP in the obese group were double that in control subjects (116 +/- 26 vs 53 +/- 30 nM P < 0.001). During the fast, ASP levels dropped progressively and were within the normal range at the end of the study (63 +/- 16 vs 53 +/- 30 nM pNS). In addition, there was a strong correlation between the plasma ASP at baseline before beginning the fast and the 4 week drop in ASP. That is, those subjects who had the highest starting ASP also had the largest 4 week drop in ASP (r2 = 0.644, P < 0.005). Of interest, as plasma ASP levels dropped, plasma free fatty acid and ketone levels rose and when all timepoints were considered, there was a significant inverse relation between plasma ASP and plasma free fatty acid (r2 = 0.295, P < 0.0002). CONCLUSIONS: The pattern of responses during the fast is that of increasing mobilization of fatty acids from adipose tissue coincident with decreased activity of the pathway responsible for the storage of adipocyte triglyceride mass. The data are consistent, therefore, with the role proposed for ASP as a major determinant of the rate of triglyceride synthesis in human adipocytes and thus a potentially important factor in the pathophysiology of obesity.

Adult↗
PubMed1997

Acute in vitro production of acylation stimulating protein in differentiated human adipocytes.

We have previously shown that in normolipidemic healthy adults, plasma acylation stimulating protein (ASP) increases postprandially and is produced in vitro by cultured differentiated human adipocytes. The present studies were undertaken to examine the influence of specific plasma components on endogenous ASP production in cultured human adipocytes. The results demonstrate that neither glucose nor fatty acids (over a wide range of concentrations) had any substantial effect on ASP production. Insulin increased ASP production up to 2-fold (208% +/- 18%, P < 0.01). However, the most profound increase in ASP was generated by the addition of chylomicrons to the cell culture medium. Chylomicrons (CHYLO) obtained from postprandial plasma increased ASP production in a time- and concentration-dependent manner, producing up to a 150-fold increase in ASP at the highest concentration of CHYLO tested (500 microg triacylglycerol/mL medium (P < 0.001)). By contrast, very low (VLDL), high (HDL), and low density lipoproteins (LDI) had only marginal effects. The effects on ASP parallelled the changes in adipocyte C3 secretion (the precursor protein of ASP). As with ASP, glucose, oleate, insulin, and hepatic lipoproteins (VLDL, LDL, and HDL) had little or no effect on C3 secretion. In contrast, CHYLO had an even greater effect on C3 secretion than on ASP generation. Finally, the effects of CHYLO on generation of ASP and C3 were not dependent on lipolysis of CHYLO by lipoprotein lipase (LPL). These results are consistent with the changes in plasma ASP seen postprandially, and suggests a role of ASP as a positive feedback regulator of triacylglycerol synthesis in adipose tissue.

Adipocytes↗
PubMed1997

Plasma acylation-stimulating protein in coronary artery disease.

To date, plasma levels of acylation-stimulating protein (ASP) have been determined only in normal and obese individuals. Accordingly. ASP was measured in fasting samples obtained from 59 age-matched controls and 208 patients with documented coronary artery disease (CAD). Overall, plasma ASP was significantly higher in the CAD subjects compared to the control subjects (55.3 +/- 1.8 nmol/L CAD versus 32.0 +/- 2.6 nmol/L control, P < .0005). In the control group, the distribution of plasma ASP values was unimodal whereas in the coronary group it was significantly skewed to the right. The coronary group was subdivided into those with pronounced elevation of apoB (a marked type II phenotype, n = 13), those with hypertriglyceridemia with a normal apoB (n = 17), and the remaining CAD subjects (n = 178). In the first two groups, ASP did not differ significantly from control subjects (43 +/- 2.8 nmol/L and 49 +/- 4.4 nmol/L respectively). By contrast, in the remaining CAD subjects, both the mean ASP level (56.8 +/- 2.0 nmol/L, P < .001 by ANOVA) and the proportion of patients with a markedly elevated ASP (25.3% were > 95th percentile, P < .005 versus control by X2) were significantly increased. When this third group was divided into tertiles by plasma apoB and triglyceride there was a direct relationship between plasma ASP and these two parameters. Linear regression analysis demonstrated an association between plasma ASP and plasma triglyceride (P < .05), VLDL cholesterol (P < .025), and VLDL apoB (P < .05). Finally, when all of the CAD subjects were divided by apoE phenotype, there appeared to be a relationship between plasma ASP and apoE phenotype such that ASP was higher in E2 subjects, intermediate in E3 subjects, and lower in E4 subjects. The present data document plasma ASP levels in a number of dyslipoproteinemic states and suggest a relation between the adipsin-ASP pathway and other metabolic determinants of lipoprotein metabolism.

Acylation↗
PubMed1997

A treadmill protocol to investigate independently the metabolic and mechanical stress of exercise.

The purpose of this study was to describe an experimental treadmill model for the independent assessment of metabolic and mechanical stress associated with exercise. Eight well-trained male runners (VO2max 61.2 ml.kg-1.min-1) undertook, on different days, three 40 min bouts (consisting of 8 x 5 min work intervals) of treadmill running: uphill, downhill and near-level. Mean %VO2 max was 90.0, 52.7 and 52.2 for uphill, near-level and downhill running respectively. Oxygen uptake increased (p < 0.05) across the eight work intervals during uphill running, with non-significant increases in both near-level and downhill running. In contrast, heart rate increased (p < 0.05) with uphill and downhill, but not near-level running. Blood lactate concentration was higher (p < 0.01) and plasma pH lower (p < 0.01) after uphill running compared with downhill and near-level running. Plasma creatine kinase activity was elevated (p < 0.05) immediately after uphill running and 24 hours after downhill running (p < 0.05). Subjective rating of delayed onset muscle soreness was elevated (p < 0.05) at 24 and 48 hours after downhill running only. There were no significant changes in the plasma concentration of the inflammatory mediators interleukin-1beta, complement component C3a and C reactive protein. Given the observed differences in cardiorespiratory responses and indicators of muscle damage and soreness, this experimental model could be employed to investigate, independently, the metabolic and mechanical stress of exercise.

Adult↗
PubMed1998

Coordinated release of acylation stimulating protein (ASP) and triacylglycerol clearance by human adipose tissue in vivo in the postprandial period.

The objective of this study was to determine whether Acylation Stimulating Protein (ASP) is generated in vivo by human adipose tissue during the postprandial period. After a fat meal, samples from 12 subjects were obtained (up to 6 h) from an arterialized hand vein and an anterior abdominal wall vein that drains adipose tissue. Veno-arterial (V-A) gradients across the subcutaneous adipose tissue bed were calculated. The data demonstrate that ASP is produced in vivo (positive V-A gradient) With maximal production at 3-5 h postprandially. The plasma triacylglycerol (TAG) clearance was evidenced by a negative V-A gradient. It increased substantially after 3 h and remained prominent until the final time point. There was, therefore, a close temporal coordination between ASP generation and TAG clearance. In contrast, plasma insulin and non-esterified fatty acid (NEFA) had an early (1-2 h) postprandial change. Fatty acid incorporation into adipose tissue (FIAT) was calculated from V-A glycerol and non-esterified fatty acid (NEFA) differences postprandially. FIAT was negative during the first hour, implying net fat mobilization. FIAT then became increasingly positive, implying net fat deposition, and overall followed the same time course as ASP and TAG clearance. There was a direct positive correlation between total ASP production and total FIAT (r = 0.566, P < 0.05). These data demonstrate that ASP is generated in vivo by human adipocytes and that this process is accentuated postprandially, supporting the concept that ASP plays an important role in clearance of TAG from plasma and fatty acid storage in adipose tissue.

Adipose Tissue↗
PubMed1998

Kinetics of bradykinin levels during and after leucocyte filtration of platelet concentrates.

OBJECTIVE: To measure bradykinin levels in platelet concentrates during and after leucocyte filtration. METHODS: Platelet concentrates were leukocyte depleted using three different leucocyte-depletion filters selected to represent filters with negative, positive or neutral charge, respectively. Bradykinin levels were analysed before, during and up to 90 min post-filtration. RESULTS: Significant levels of bradykinin were generated when negatively charged leucocyte depletion filters were used. However, we found a high variation between platelet concentrates prepared from different donors as well as within the same concentrate when this was divided into three aliquots. Generated bradykinin was rapidly degraded in the collection bag and no bradykinin was detectable 60 min post-filtration. CONCLUSION: Bradykinin generation is more pronounced when negatively charged leucocyte removal filters are used. Due to a rapid degradation of bradykinin in the storage bag, pre-storage filtration should minimise the risk of bradykinin related adverse reactions during transfusion with some filters.

Adolescent↗
PubMed1991

Activation of the complement cascade by trypsin.

In twenty-three patients with acute pancreatitis, the plasma levels of immunoreactive trypsin were determined with a RIA method. The patients were divided into groups according to the severity of the disease. Ranson's criteria and the development of multisystem organ failure were used for the classification. Elevated plasma levels of immunoreactive trypsin were found in all groups after admittance. Incubation of fresh human serum and plasma with bovine trypsin in concentrations between 10(-6) and 10(-4) M at 20 degrees C activated the complement cascade. The anaphylatoxins C3a and C5a were determined with a RIA and the terminal complement complex (TCC) with an ELISA method. C3a and C5a were released and TCC was formed. The effect of trypsin on leukocyte activation was determined with a chemiluminescence technique. Trypsin dissolved in saline did not activate the leukocytes. However, serum digested by trypsin-activated leukocytes in a dose-dependent manner. The present study supports the theory that trypsin can activate complement components and results in formation of split products which have potent vascular, and leukocyte activating effects.

Acute Disease↗
PubMed1994

Complement activation during cardiopulmonary bypass: effects of immobilized heparin.

The role of complement in biocompatibility reactions and the correlation between complement activation during cardiopulmonary bypass (CPB) and postperfusion syndrome have inspired attempts to improve the biocompatibility of extracorporeal blood oxygenation devices. Here we assessed the effect of immobilized heparin on the generation of C3a and terminal complement complexes during CPB. Thirty patients undergoing aortocoronary bypass were randomized to CPB with either heparin-coated (Duraflo II; Bentley, Irvine, CA) or noncoated control membrane oxygenators (Univox; Bentley). A standard dose of heparin (300 IU/kg) was given to the control group while the heparin dose was reduced to 30% (100 IU/kg) in the heparin-coated group. Significantly lower levels of terminal complement complexes were detected in the heparin-coated group by the end of CPB. From 28 +/- 5 AU/mL (heparin-coated group) and 26 +/- 3 AU/mL (control group, mean +/- standard error of the mean) the terminal complement complex levels increased to 391 +/- 35 AU/mL and 602 +/- 47 AU/mL, respectively (p < 0.002). This difference was still apparent 180 minutes after CPB. Although there was no difference in C3a levels between the two groups at the end of CPB, C3a levels were significantly lower in the heparin-coated group 30 minutes after CPB (194 +/- 18 ng/mL and 307 +/- 18 ng/mL in heparin-coated and control groups, respectively; p < 0.001). We conclude that the heparin-coated surface is more biocompatible with regard to complement activation than is the ordinary unmodified surface in extracorporeal circuits.

Biocompatible Materials↗
PubMed1996

Ultrafiltration after cardiopulmonary bypass in children: effects on hemodynamics, cytokines and complement.

OBJECTIVES: The purpose of the study was to evaluate the clinical and hemodynamic effect of intraoperative extracorporeal ultrafiltration (UF) and its potential in reducing the plasma concentration of circulating cytokines and complement activation products following open heart surgery in children. METHODS: Eighteen children with congenital heart disease were prospectively randomized into a control group (n = 9) and a group who underwent UF (n = 9). Serial plasma samples for measurements of circulating cytokines (interleukin 6 (IL-6), tumor necrosis factor alpha (TNF), and its soluble receptor (sTNF receptor)), and complement factors (C3 activation products (C3a and C3bc) and terminal complement complex (TCC)) were obtained before, during and up to 48 h after cardiopulmonary bypass (CPB). A pulmonary artery thermodilution catheter was introduced preoperatively for hemodynamic monitoring. RESULTS: Postoperative hemodynamics were similar in both groups. Plasma levels of IL-6, sTNF receptors, C3a, C3bc and TCC increased significantly perioperatively (P < 0.01) in both groups. TNF was detected transiently in 16 patients perioperatively and in 4 of the 9 ultrafiltrate samples in concentrations similar to the plasma levels. Complement activating products were not detected in the ultrafiltration samples except for small amounts of C3a in two cases. Compared to the control group the plasma levels of C3a, C3bc and TCC were unaffected by the ultrafiltration procedure. The level of IL-6 and sTNF receptors increased significantly after 15 min of UF but there was no significant difference between the two groups postoperatively. CONCLUSIONS: In this study no clinical or hemodynamic effect was registered after UF. TNF and C3a were occasionally detected in the ultrafiltrate but we were unable to demonstrate reduction of these or any of the other markers tested in the group subjected to ultrafiltration.

Cardiopulmonary Bypass↗
PubMed1977

[Anaphylactoid purpura and the complement system: particularly in terms of C3a and IgA (author's transl)].

We measured the immunoglobulin, beta1 C globulin, beta1E globulin, C3a, and CH50 in 20 patients with anaphylactoid purpura (Schönlein-Henoch purpura). IgA values proved to be elevated in 5 out of 11 cases. beta1 C globulin values were lower in 2 out of 8 cases and fell within the range of normalcy in the remaining 6 cases. beta1 E globulin values were normal in all cases measured (5 patients). A 130% increase in C3a was found in 7 out of 9 cases; patients with higher C3a values suffered from lasting petechial hemorrhages. It can, therefore, be concluded that the activation of the "alternative pathway" induced by IgA led to the release of C3a.

Child↗
PubMed1988

Synthetic peptide inhibitors of complement serine proteases--II. Effects on hemolytic activity and production of C3a and C4a.

Synthetic peptides based on the amino acid sequence at the site of cleavage of C3 by classical and alternative pathway convertases were found to be poor inhibitors of hemolysis except at concns of 1 mM and higher. Synthetic peptides of a second type, based on the C-terminal sequence of antithrombin III, were more effective; the best among them caused significant inhibition of hemolysis at a concn of 5 microM. A hybrid peptide composed of the sequence at the site of cleavage of C4 by C1s attached to an antithrombin III sequence was selective, inhibiting the classical pathway with no effect on the alternative pathway at a concentration of 25 microM. Several of the antithrombin III peptides that inhibited hemolysis did not inhibit C4 activation by the classical pathway or activation of C3 by the classical and alternative pathways suggesting that these peptides affect hemolysis by inhibiting enzymes other than C1s and C4b2a of the classical pathway and C3bBb of the alternative pathway.

Amino Acid Sequence↗
PubMed1996

Heparin-coated cardiopulmonary bypass circuits in coronary bypass surgery.

Cardiopulmonary bypass (CPB) is a nonphysiologic environment for an organism. The damage of blood components may also lead to organ dysfunction, some-times recognized as postperfusion syndrome. One possible way to diminish the risk of these complications would be to reduce the thorombogenicity and to improve the biocompatibility of the artificial surfaces by using a heparin-coated CPB circuit. In this study, we compared a heparin-coated CPB circuit with a noncoated CPB circuit in terms of biocompatibility in 20 patients undergoing elective coronary bypass surgery. We employed a Duraflo II (n = 10) as a heparin-coated CPB circuit and a Univox IC (n = 10) as control subjects. Ten patients (Group C) were operated on using the heparin-coated CPB circuit. A total of 10 patients were given heparin in a reduced dose (2.0 mg/kg), and additional heparin was given if the activated clotting time (ACT) was below 400 s. The control group also included 10 patients (Group NC), who were operated on with noncoated devices. They received 2.5 mg/kg of heparin, and additional heparin was given if the ACT was below 450 s. All patients had normal coagulation parameters and did not receive blood transfusion. We measured complement activation levels (C3a, C4a), platelet count, thrombin-antithrombin III complex levels, D-dimer levels, and ACT during CPB and respiratory index postoperatively. The concentration of C3a in group NC was significantly higher than that in group C. Platelet reduction in group NC was significantly greater than that in group C. There were no significant differences in the remaining parameters between the 2 groups. We concluded that heparin-coated CPB circuits improved biocompatibility by reducing complement activation and platelet consumption and enabled us to reduce the dose of heparin required for systemic heparinization.

Adult↗
PubMed1997

Role of C3a and C5a in the activation of mast cells.

Mast cells and basophils are known to be triggered by allergens via cross-linking with their high-affinity IgE-binding receptors, Fc epsilon RI. The anaphylatoxic activity of the complement-derived peptides C3a and C5a has been known for a long time; however, it has also been reported that serosal- and mucosal-type mast cells respond differently to peptidergic stimuli. The mechanism of mast cell activation by cross-linking of Fc epsilon RI has been the subject of intensive studies in the past few years, while the action mode of the anaphylatoxic complement peptides has been revealed only recently. We report about a novel function of C3a: its inhibitory activity on IgE-mediated triggering of the mucosal RBL-2H3 cells. Surprisingly, the other anaphylatoxic peptide C5a, which has been shown to be significantly more effective in several biological assays, did not influence antigen-induced triggering of the RBL-2H3 cell line at all.

Animals↗
PubMed1998

White blood cell counts and plasma C3a have synergistic predictive value in patients at risk for acute respiratory distress syndrome.

OBJECTIVE: To investigate and select nonassociated variables with predictive value for acute respiratory distress syndrome (ARDS) in patients at risk. DESIGN: Prospective, observational study. SETTING: A university hospital intensive care unit. PATIENTS: Twenty-four critically ill patients with different risk factors for ARDS. INTERVENTIONS: Arterial and mixed venous blood, as well as urine samples, were collected. Invasive hemodynamic measurements were performed. MEASUREMENTS AND MAIN RESULTS: Fifty-nine variables pertaining to the cardiorespiratory, hepatic, immunologic, and renal systems and including plasma complement activation products C3a and SC5b-9 and polymorphonuclear elastase, were determined every 6 hrs for 3 days in patients at risk for ARDS. Associations among variables were investigated and the predictive value of nonassociated variables for ARDS was determined. Patients who developed ARDS (n=8) had lower white blood cell counts at the time they entered the study (p=.006) and during the first 24 hrs thereafter (p=.032). Also, plasma C3a concentrations were markedly higher during the first 24 hrs in patients who developed ARDS (p=.006). Plasma C3a had better predictive value than did white blood cell counts for cutoff points set by discriminant analysis at 1075 ng/mL (1.075 x 10(-3) g/L) and 5700 cells/mL, respectively. The combination of both variables in a discriminant function improved the predictive value for ARDS. CONCLUSIONS: The most notable and nonassociated alterations observed in patients who developed ARDS were lower white blood cell counts and higher plasma C3a concentrations compared with counts and concentrations in patients who did not develop ARDS. Plasma C3a concentrations showed better predictive value than white blood cell counts. The combination of white blood cell counts with plasma C3a concentrations synergistically improved the predictive value for ARDS. This combination may prove useful for identifying subpopulations at highest risk for ARDS and may contribute to make treatment at an early stage of the syndrome possible.

Adolescent↗
PubMed1993

Mediators of complement-independent granulocyte activation during haemodialysis: role of calcium, prostaglandins and leukotrienes.

Granulocyte activation during haemodialysis using cuprophane membrane is mediated by complement-derived anaphylatoxins C3a and C5a. However, neutrophil degranulation induced by modified cellulosic membranes or synthetic membranes does not correlate with C3a or C5a concentrations. Incubation and recirculation experiments were performed to find out which messengers trigger neutrophil degranulation during blood contact with different membrane materials. During in vitro haemodialysis for 2 hours, PMMA and cuprophane induced pronounced degranulation of neutrophils. With PMMA this was associated with increased thromboxane B2 but low C3a levels, while with cuprophane membrane, marked complement activation but only little thromboxane B2 release was observed. Indomethacin (10 microM) nullified all thromboxane B2 response but could not influence elastase release, indicating that cyclo-oxygenase products are not involved in neutrophil degranulation under these conditions. During incubation of blood with dialysis membranes, inhibition of lipoxygenase by esculetin or of phospholipase A2 by hydrocortisone also had no effect on neutrophil degranulation. One messenger involved in granulocyte activation might be free cytosolic calcium. Application of different calcium channel blockers (verapamil, diltiazem, or nitrendipine) did not influence neutrophil degranulation in incubation experiments, in PMMA or cuprophane membranes. In contrast, chelation of plasmatic calcium by sodium citrate or EDTA blunted elastase release induced by these membranes. This study indicates that calcium is a key mediator required for neutrophil degranulation in complement-activating and non-complement-activating dialysis membranes, while activation of the prostaglandin or leukotriene cascade are not required.

Adult↗
PubMed2000

Clinical performance of a new high-flux synthetic membrane.

The clinical performance during first use of a new membrane manufactured from a blend of polyarylethersulfone and polyvinylpyrrolidone (Arylane; Hospal Renal Care, Lyon, France), in which the microstructure of the membrane has been tailored by the manufacturing process and polymer blend, has been compared with Fresenius Polysulfone (Fresenius Medical Care, Bad Homburg, Germany) in a prospective, randomized, crossover study. Small-molecular clearances were similar. A reduction in plasma beta(2)-microglobulin levels was present using both membranes, with a significantly greater removal by Arylane such that the mean postdialysis plasma level difference between the membranes at the end of dialysis was 8. 7 mg/L (95% confidence interval, 3.9 to 13.5; P = 0.004). Recovery of beta(2)-microglobulin from the dialysis fluid was similar: 170 +/- 70 mg for Arylane and 110 +/- 60 mg for Fresenius Polysulfone (P = 0.04). Both membranes were impermeable to albumin but allowed the passage of low-molecular-weight proteins, with 10,046 +/- 3,239 mg for Arylane and 7,285 +/- 2,353 mg for Fresenius Polysulfone recovered from the dialysis fluid (P = 0.07). Neutropenia and platelet adhesion to the membrane were minimal, and time-averaged complement levels during dialysis for C3a and C5b-9 were 207 +/- 92 and 62 +/- 24 ng/mL for Arylane and 223 +/- 68 and 45 +/- 24 ng/mL for Fresenius Polysulfone, respectively, and were membrane independent. This study indicates that the membrane using polyarylethersulfone in conjunction with PVP has complement-activation potential and neutropenia similar to Fresenius Polysulfone but has an enhanced capacity to remove beta(2)-microglobulin. This enhanced removal arises from transmembrane transport augmented by adsorption within the membrane matrix.

Biocompatible Materials↗
PubMed1983

[Effects of lysozyme treatment on immune reactions in viral hepatitis. Preliminary report].

The effect of orally administered Lysozyme (2 g per diem for 6-15 days) on serum immunoglobulins, C3 complement component, its C3A properdine activator and intestinal flora was studied in 45 subjects with acute viral hepatitis. Comparison of the data before and after treatment revealed a significant decrease in IgA, IgM and C3A and an equally significant increase in C3. Coproculture tests revealed important changes in many case in which one or more pathogenetic species (Enterobacter, Proteus, Citrobacter) had completely disappeared. The mechanisms used by Lysozyme in the modulation of immunological responses during viral hepatitis are discussed. These include reduction of the enteric antigen stimulus by inhibiting the growth of bacterial flora, the blocking of anti-complement factors and the modification of antibody response.

Adolescent↗