Case report: an unusual reaction to foods?
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Diagnosis, Differential↗
Biomedical subjects
M G Tonnesen
Publications and source records attributed to M G Tonnesen.
Interaction between chemoattractants and bacterial lipopolysaccharide in the induction and enhancement of neutrophil adhesion.
Chemotactic peptides in the circulation stimulate neutrophils to become sequestered in the pulmonary vasculature, and low concentrations of bacterial lipopolysaccharide (LPS) enhance and prolong this effect. This interaction of neutrophils with the vascular endothelium is thought to involve, in part, the increase in adhesiveness induced in neutrophils by such stimuli. In this study, the binding of albumin-coated latex beads to neutrophils was used to determine whether the enhancement seen with LPS results from an increase in the number of adhesive cells, from the enhancement of the adhesiveness of individual neutrophils, or both. Chemotactic peptides alone and LPS alone induced an increase both in the adhesive population and in the number of beads bound per individual neutrophil. The number of beads bound per cell increased over a very wide range of stimulus concentrations, showing that the degree of adhesiveness of an individual cell in the population varies over a considerable range. Trace concentrations of LPS (10 ng/ml or less), i.e., levels close to those measurable in vivo, had little effect on the proportion of neutrophils that were stimulated by chemotactic factor to become adhesive but did significantly enhance the number of beads bound to each individual neutrophil. The enhancement may require the presence of the CD11/18 glycoprotein complex, but was not further upregulated by LPS. No evidence could be obtained to suggest that the effect of LPS involved release of tumor necrosis factor (TNF) from the numbers of monocytes in the preparation, and the observations are consistent with a direct effect of LPS on the neutrophils. It is suggested that this increase in adhesive sites on the cell could explain the persistence of the sequestration of neutrophils in the microvasculature seen in the presence of both chemoattractants and LPS by enhancing the "strength" of the adhesion to endothelial cells. The increased adhesion may also set the stage for enhanced endothelial injury.
Antigens, CD↗
Neutrophil-endothelial cell interactions: mechanisms of neutrophil adherence to vascular endothelium.
Adherence of circulating neutrophils to the microvascular endothelium is the initial step in diapedesis, the process by which leukocytes migrate through blood vessels to accumulate at sites of cutaneous disease or injury. The mechanisms underlying neutrophil-endothelial cell interactions are currently under intense investigation. It has now been clearly shown that human neutrophil adherence in vitro to cultured human endothelial cell monolayers can be enhanced by a variety of mediators of inflammation, that both the neutrophil and the endothelial cell may actively contribute to the adhesive interaction depending on the stimuli involved, and that the Mac-1, LFA-1, p150,95 glycoprotein family (CD11/CD18) plays a critical role. Chemotactic peptides (FMLP, C5a) and lipid mediators (LTB4, PAF) act primarily on the neutrophil to enhance its adherence to endothelium. The effect occurs quickly (maximal response within 2 min), can be rapidly modulated, and is dependent on the expression of CD11/CD18 on the neutrophil surface. In contrast, the cytokines, interleukin-1 (IL-1) and tumor necrosis factor (TNF), as well as bacterial lipopolysaccharide (LPS), induce cultured human endothelial cells to increase their adhesivity for human neutrophils by a process that is time-dependent, requiring 4 to 6 h for maximal response, and involves de novo RNA and protein synthesis. Two adhesion molecules are induced on the surface of endothelium in response to cytokine activation: endothelial-leukocyte adhesion molecule-1 (ELAM-1) and intercellular adhesion molecule-1 (ICAM-1). ICAM-1 is a ligand for LFA-1 (CD11a/CD18). Thus, CD11/CD18 plays a central role in neutrophil adherence to endothelium stimulated by chemotactic factors or cytokines. However, much still remains to be explored to further understanding of the fascinating but complex interaction of circulating neutrophils and the microvascular endothelium during acute inflammatory reactions in the skin.
Biomechanical Phenomena↗
Adherence of neutrophils to cultured human microvascular endothelial cells. Stimulation by chemotactic peptides and lipid mediators and dependence upon the Mac-1, LFA-1, p150,95 glycoprotein family.
The process of neutrophil adhesion to and migration through the microvascular endothelium, an early event in the induction of the acute inflammatory response, has been attributed to the generation of extravascular chemoattractants. Although both chemotactic peptides and lipid mediators enhance neutrophil adherence in vitro and in vivo, the mechanism(s) involved in the interaction between circulating neutrophils and microvascular endothelial cells is still not completely understood. In a microtiter well adherence assay, the chemotactic peptides, FMLP and C5a, and the lipid mediators, leukotriene B4 (LTB4) and platelet activating factor (PAF), enhanced human neutrophil adherence to cultured human microvascular endothelial cells as well as to human umbilical vein endothelial cells in a dose-dependent manner with a rapid time course. This stimulated adhesive interaction between neutrophils and cultured human endothelial cells was dependent on the expression of the Mac-1, LFA-1, p150,95 glycoprotein family on the neutrophil surface since neutrophils from patients with leukocyte adhesion deficiency, lacking surface expression of the adhesive glycoproteins, exhibited markedly diminished adherence to human endothelial cells in response to stimulation with chemotactic factors compared to normal control neutrophils. All four mediators enhanced expression of the glycoprotein family on the surface of normal neutrophils as determined by flow cytofluorimetry using a monoclonal antibody (TS1/18) to the glycoprotein common beta subunit. In addition, TS1/18 inhibited up to 100% the adherence of normal neutrophils to endothelial cells stimulated by maximal concentrations of FMLP, C5a, LTB4, or PAF. Moreover, HL-60 cells, human promyelocytic leukemia cells, neither increased glycoprotein surface expression nor adherence in response to stimulation. Thus, peptide and lipid mediators of the acute inflammatory response appear to enhance adherence of circulating neutrophils to the microvascular endothelium by a mechanism dependent on expression of the Mac-1, LFA-1, p150,95 glycoprotein family on the neutrophil surface.
Antigens, Differentiation↗
Stimulation of eosinophil adherence to human vascular endothelial cells in vitro by platelet-activating factor.
111In-Labeled eosinophils from mildly eosinophilic subjects have been examined for their capacity to adhere to cultured human umbilical vein endothelial cells. In assay buffer alone, 32.0% +/- 2.6 eosinophils adhered spontaneously to endothelial cells. Platelet-activating factor (PAF) (1-alkyl-2-acetyl-sn-glycero-3-phosphorylcholine) at concentrations as low as 10(-9) M increased this adherence to a level of 46.7% +/- 2.0. The effects of PAF were confirmed to be on eosinophils by parallel adherence assays done on serum-coated plastic plates where comparably enhanced adhesion of the eosinophils was seen. Lyso-PAF, the biologically inactive precursor/metabolite of PAF, had no stimulatory properties. FMLP caused an increase in eosinophil adherence, comparable to that of PAF, but only at high concentrations (10(-6) to 10(-7) M). Further examination of eosinophil subpopulations separated on metrizamide gradients indicated that "hypodense" eosinophils had a significantly higher ability to adhere spontaneously to endothelial cells than "normal" dense eosinophils, (35.5% +/- 4.2 vs 23.8% +/- 2.5, respectively) and could be stimulated with PAF to higher levels, although the magnitude of stimulation was similar for both populations. A mouse mAb TS1/18 to the common beta-subunit of the Mac-1 cell surface glycoprotein complex (CDw18) reduced by up to 94.6% the PAF-induced increase in adherence, but had no effect on the spontaneous adhesion. Eosinophils were also shown by cytofluorography to be capable of binding the TS1/18 antibody on their cell surface, and in some experiments to exhibit an increased expression of the Mac-1 complex on stimulation with PAF. These studies indicate that eosinophils are capable of binding to endothelial cells in culture, that PAF is a potent stimulator of eosinophil adherence, and that the Mac-1 complex has a critical role in this adhesion process.
Antibodies, Monoclonal↗
Human monocyte adherence: a primary effect of chemotactic factors on the monocyte to stimulate adherence to human endothelium.
Monocyte emigration into areas of inflammation is initiated by monocyte adherence to the microvascular endothelium which may be induced by the local production of chemotactic factors at the inflammatory site. However, it is not clear whether such stimuli act on the monocyte and/or the endothelial cell to promote this effect. Accordingly, the effect of the chemotactic peptides C5a des arg and formyl-methionyl-leucyl-phenylalanine (FMLP) on human monocyte adherence to human microvascular endothelial cell monolayers was investigated in vitro. Monocytes (92 to 98% pure) were isolated by discontinuous plasma-Percoll density gradients and cell elutriation, methods designed to minimize monocyte exposure to endotoxin. Mean spontaneous (unstimulated) adherence of 111Indium-tropolonate-radiolabeled monocytes to microvascular endothelial cell monolayers was 19.7% +/- 1.3. Monocyte adherence to microvascular endothelial cell monolayers was stimulated in a dose-response fashion in the presence of C5a des arg or FMLP to a maximum mean adherence of 47.2% +/- 2.9 or 43.8% +/- 2.2, respectively. C5a des arg or FMLP stimulated monocytes to adhere to monolayers of human vascular smooth muscle cells, human dermal fibroblasts, or serum-coated plastic wells in a comparable fashion as to endothelial cells. The simultaneous presence of both chemotactic peptides C5a des arg and FMLP in the assay system stimulated monocyte adherence to the same degree as either stimulus alone. This finding suggested that those monocytes stimulated to adhere by C5a des arg were the same subpopulation responding to FMLP. Spontaneous monocyte adherence (in the absence of chemotactic peptides) to both endothelial cell monolayers and serum-coated plastic wells was reduced in the presence of plasma, but chemotactic peptides induced a significant, albeit reduced, adhesion of monocytes in this circumstance. The pretreatment of monocytes with either C5a des arg or FMLP prior to the adherence assay induced stimulus-specific desensitization of monocyte adherence. Neither a desensitization nor stimulated monocyte adherence occurred when endothelial cell monolayers or serum-coated plastic wells were pretreated with either of the chemotactic peptides. The fixation of endothelial cell monolayers prior to the adherence assay did not alter the degree of spontaneous, C5a des arg-stimulated, or FMLP-stimulated monocyte adherence. These data suggest that the stimulated adhesion of monocytes to endothelial cells by C5a des arg or FMLP represents primarily an effect of these chemotactic peptides on the monocyte.
Cell Adhesion↗
Isotretinoin produces significant inhibition of monocyte and neutrophil chemotaxis in vivo in patients with cystic acne.
The effect of oral isotretinoin (13-cis-retinoic acid) on in vivo chemotactic responses was studied longitudinally in 7 patients with cystic acne. As measured in a microchamber chemotaxis assay, both monocyte and neutrophil chemotaxis were inhibited 98% (p less than 0.001) during isotretinoin treatment. In vivo chemotactic responses returned to normal within 2 months of cessation of treatment. Biopsies of skin chamber sites from patients on isotretinoin showed no significant dermal or epidermal leukocytic accumulation in response to autologous zymosan-activated serum, whereas chambers from controls showed extensive neutrophilic infiltrates even in the epidermis. In contrast, in vitro chemotactic responses of neutrophils and monocytes from patients on isotretinoin were not diminished. Sera and plasma from patients on isotretinoin contained no inhibitors of chemotaxis, and activated sera from these patients were excellent attractants for normal monocytes. We postulate that isotretinoin produces significant anti-inflammatory effects by inhibition of monocyte and neutrophil chemotaxis across intact biologic barriers in vivo.
Acne Vulgaris↗
Effects of shear stress on adhesive interaction between neutrophils and cultured endothelial cells.
The effect of hydrodynamic shear stress on the adhesive interaction between neutrophils and endothelial cells in vitro was investigated using an apparatus similar to a cone-in-plate viscometer. Isolated bovine neutrophils were labeled with 111In and incubated with monolayers of cultured bovine pulmonary arterial endothelial cells in the presence of different degrees of shear stress. Physiologically relevant shear (less than 2 dyn/cm2) was associated with marked decrease in neutrophil adherence. Stimulation with 10% bovine zymosan-activated plasma increased adherence under static conditions but failed to increase adherence conducted during the application of shear stress. Inhibition of endothelial cell prostacyclin production by meclofenamate or aspirin failed to alter the response to shear. Incubation of neutrophils under static conditions for 10, but not 5, min however, markedly enhanced subsequent resistance to shear, suggesting that a time-dependent reaction between neutrophil and endothelial cell was required to induce an increase in the strength of adherence. Analysis of neutrophil migration underneath the monolayer indicated that such migration in no way accounted for resistance to shear, particularly since shear resistance was enhanced on serum-coated plastic as well as endothelial cells. We conclude that hemodynamic factors may play an important role in modulating neutrophil adherence to endothelium in both normal and inflammatory states.
6-Ketoprostaglandin F1 alpha↗
Neutrophil-mediated injury to endothelial cells. Enhancement by endotoxin and essential role of neutrophil elastase.
The neutrophil has been implicated as an important mediator of vascular injury, especially after endotoxemia. This study examines neutrophil-mediated injury to human microvascular endothelial cells in vitro. We found that neutrophils stimulated by formyl-methionyl-leucyl-phenylalanine (FMLP), the complement fragment C5a, or lipopolysaccharide (LPS) (1-1,000 ng/ml) alone produced minimal endothelial injury over a 4-h assay. In contrast, neutrophils incubated with endothelial cells in the presence of low concentrations of LPS (1-10 ng/ml) could then be stimulated by FMLP or C5a to produce marked endothelial injury. Injury was maximal at concentrations of 100 ng/ml LPS and 10(-7) M FMLP. Pretreatment of neutrophils with LPS resulted in a similar degree of injury, suggesting that LPS effects were largely on the neutrophil. Endothelial cell injury produced by LPS-exposed, FMLP-stimulated neutrophils had a time course similar to that induced by the addition of purified human neutrophil elastase, and different from that induced by hydrogen peroxide (H2O2). Further, neutrophil-mediated injury was not inhibited by scavengers of a variety of oxygen radical species, and occurred with neutrophils from a patient with chronic granulomatous disease, which produced no H2O2. In contrast, the specific serine elastase inhibitor methoxy-succinyl-alanyl-alanyl-prolyl-valyl-chloromethyl ketone inhibited 63% of the neutrophil-mediated injury and 64% of the neutrophil elastase-induced injury. However, neutrophil-mediated injury was not inhibited significantly by 50% serum, 50% plasma, or purified alpha 1 proteinase inhibitor. These results suggest that, in this system, chemotactic factor-stimulated human neutrophil injury of microvascular endothelial cells is enhanced by small amounts of LPS and may be mediated in large part by the action of neutrophil elastase.
Amino Acid Chloromethyl Ketones↗
Expression of fibronectin, laminin, and factor VIII-related antigen during development of the human cutaneous microvasculature.
The regulation of angiogenesis during human skin development is poorly understood. Since fibronectin is involved in cell movement and organization during embryogenesis and morphogenesis in a variety of species, we investigated the expression of fibronectin and factor VIII-related antigen, a marker for endothelial cells, at various stages in the development of the human cutaneous microvasculature. Skin specimens were obtained from 4 human fetuses during the second trimester (14-18 weeks), from newborn foreskins, and from consenting normal adults. Cryostat sections were stained with both fluorescein-conjugated rabbit antihuman fibronectin and rhodamine-conjugated goat antihuman factor VIII-related antigen. Expression of fibronectin in the microvasculature was striking in fetal skin but became progressively less prominent with maturation. Fibronectin appeared in fetal blood vessels as a bright continuous linear array, in neonatal blood vessels as a bright interrupted linear and speckled array, and in adult blood vessels as a sparse interrupted linear and speckled array. In contrast, expression of factor VIII-related antigen by the endothelium became more prominent with the degree of maturation of the microvasculature. Granular factor VIII-related antigen staining was scant in the newly forming blood vessels of fetal skin, bright but focal in the microvasculature of newborn skin, and intense and almost confluent in the blood vessels of adult skin. Although expression of fibronectin and factor VIII-related antigen changed, expression of laminin was consistent throughout development. Staining of the same skin specimens with fluorescein-conjugated sheep antihuman laminin produced a bright continuous linear pattern in all blood vessels. The reciprocal relationship manifested by intense fibronectin staining during human blood vessel development and prominent factor VIII-related antigen staining in mature blood vessels supports the hypotheses that fibronectin plays a role in human blood vessel modulation and morphogenesis, and that factor VIII-related antigen is a marker for endothelial cell differentiation.
Adult↗
Identification of a human neutrophil angiotension II-generating protease as cathepsin G.
A human neutrophil protease, initially termed neutral peptide-generating protease, has been shown to cleave angiotensin II directly from angiotensinogen and has been identified as leukocyte cathepsin G. When purified neutrophils were disrupted by nitrogen cavitation and fractionated by differential centrifugation, 44 and 24% of the angiotensin II-generating activity was in the lysosomal and undisrupted cell fractions, respectively. Cytochalasin B-treated human neutrophils stimulated with N-formyl-L-methionyl-L-leucyl-L-phenylalanine released beta-glucuronidase, lysozyme, and angiotensin II-generating protease in a dose-dependent fashion, consistent with localization of this protease to the neutrophil granule. Individually purified angiotensin II-generating protease and cathepsin G had similar proteolytic and esterolytic activity for angiotensinogen and N-benzoyl-L-tyrosine ethyl ester on a weight basis, exhibited identical mobilities by SDS-gradient polyacrylamide gel electrophoresis and pH 4.3 disc-gel electrophoresis, and gave precipitin lines of antigenic identity on Ouchterlony analysis with goat antibody to the angiotensin II-generating protease. Thus, the angiotensin II-generating protease of human neutrophils has been identified as cathepsin G on the basis of subcellular localization, substrate specificity, physicochemical characteristics, and antigenic identity.
Angiotensin II↗
Erythema multiforme.
Erythema multiforme (EM) is an episodic, variable, self-limited, and often recurrent inflammatory disorder of the skin and mucous membranes. In this article a definition of EM is proposed, its known clinical and histopathologic spectrum is reviewed, an approach to diagnosis and treatment is suggested, and documented evidence regarding its etiology and pathogenesis is presented. EM would appear to be a hypersensitivity reaction to a variety of precipitating agents. It has been directly linked to Mycoplasma pneumoniae and herpes simplex virus infections and possibly is triggered by a number of other infectious agents and by certain drugs. Accumulating observations of diverse immunologic phenomena suggest an underlying immune mechanism of as yet unclear type. Future investigation should be directed toward defining diagnostic criteria, evaluating reported etiologic associations, and clarifying the immunologic basis of this complex and enigmatic disorder.
Diagnosis, Differential↗
Circadian variation of prostaglandin E(PGE) production in human gastric juice.
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Adult↗