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Biomedical subjects

N H Valerius

Publications and source records attributed to N H Valerius.

At least 37 records · Page 2Linked to original sources

Fluoroquinolones in the treatment of cystic fibrosis.

Cystic fibrosis patients suffer from recurrent and chronic lung infections mainly caused by Staphylococcus aureus, Haemophilus influenzae and Pseudomonas aeruginosa. The fluoroquinolones, notably ciprofloxacin and ofloxacin, represent an important addition to the therapy of P. aeruginosa infections. They offer the possibility of effective oral treatment for early colonisation as well as chronic infections, even in children. They are associated with only few and mild adverse effects. Development of resistance represents an increasing problem.

Ciprofloxacin↗

Chronic granulomatous disease with partial deficiency of cytochrome b558 and incomplete respiratory burst: variants of the X-linked, cytochrome b558-negative form of the disease.

Five male patients from four different families presented with a clinical record of chronic granulomatous disease (CGD): recurrent infections of the skin and/or respiratory tract with catalase-positive microorganisms, sometimes in combination with granulomata and/or abscesses in various organs. These patients differed from "classical" forms of the disease in that their neutrophils, although deficient in killing in vitro of Staphylococcus aureus, contained a decreased but measurable amount of cytochrome b558 (10-60% of normal on a heme basis), causing weak staining in the nitroblue tetrazolium dye test and a depressed respiratory burst after contact of the cells with fluid or particulate activators of the NADPH:O2 oxidoreductase. In the cell-free activation system, the defect in the patients' cells was localized in the membrane fraction. In each of the four families, the cellular abnormalities showed an X-linked inheritance. Fusion experiments performed with the monocytes from these patients and those from patients with classical X-linked, cytochrome b558-negative (Xb(0)) or autosomal, cytochrome b558-positive (Ab+) CGD showed complementation of NADPH:O2 oxidoreductase activity in the latter but not in the former combination. Thus, the unusual CGD patients represent variant forms of Xb(0) CGD, with mutations in the gene coding for the beta subunit of cytochrome b558 that do not cause complete loss of this protein.

Blood Bactericidal Activity↗

Prevention of chronic Pseudomonas aeruginosa colonisation in cystic fibrosis by early treatment.

To assess whether chronic pulmonary colonisation with Pseudomonas aeruginosa in cystic fibrosis is preventable, 26 patients who had never received anti-pseudomonas chemotherapy were randomly allocated to groups receiving either no anti-pseudomonas chemotherapy or oral ciprofloxacin and aerosol inhalations of colistin twice daily for 3 weeks, whenever Ps aeruginosa was isolated from routine sputum cultures. During the 27 months of the trial, infection with Ps aeruginosa became chronic in significantly fewer treated than untreated subjects (2 [14%] vs 7 [58%]; p less than 0.05) and there were significantly fewer Ps aeruginosa isolates in routine sputum cultures in the treated group (49/214 [23%] vs 64/158 [41%]; p = 0.0006). Thus, chronic colonisation with Ps aeruginosa can be prevented in cystic fibrosis by early institution of anti-pseudomonas chemotherapy.

Child↗

Endotoxemia and enhanced generation of oxygen radicals by neutrophils from patients undergoing cardiopulmonary bypass.

Plasma endotoxin concentrations and oxidative burst response of peripheral blood polymorphonuclear leukocytes were examined in 12 patients undergoing coronary artery bypass. The measurements were made just before the operation, 5 minutes after removal of the aortic crossclamp, and 24 hours after the operation. Endotoxin was quantitated by a combination of a sensitive Limulus amebocyte lysate assay and rocket immunoelectrophoresis measuring picogram amounts of endotoxin. Peripheral blood neutrophils were purified by a two-step dextran sedimentation and metrizoate sodium Ficoll (Lymphoprep., Nyegaard, Oslo, Norway) centrifugation. The oxidative burst response of these cells was measured for their ability to generate superoxide anion and was determined by a cytochrome c reduction assay. Preoperatively, all the plasma samples except one were free of endotoxin. The endotoxin levels reached 100 pg/ml 5 minutes after removal of the aortic crossclamp, and except in one sample they had decreased 24 hours after the operation. Studies on the generation of superoxide by neutrophils showed a decline in the response 5 minutes after removal of the aortic crossclamp and an enhancement of the response to f-Met-Leu-Phe by cells obtained from 11 of 12 patients 24 hours postoperatively. In vitro addition of bacterial lipopolysaccharide to blood from healthy individuals also enhanced the superoxide response of the neutrophils. We conclude that during cardiopulmonary bypass the circulating blood is contaminated by endotoxin and the neutrophils are primed for enhanced generation of oxygen radicals. The released oxygen radicals may be involved in the tissue damage observed in these patients.

Aged↗

Thalidomide enhances superoxide anion release from human polymorphonuclear and mononuclear leukocytes.

The effect of thalidomide on the function of human polymorphonuclear leukocytes (PMNs) and blood monocytes was tested in vitro. The chemotactic and spontaneous migration was not affected by thalidomide between 0.001 and 0.1 mg/ml. PMN oxygen consumption was not changed after pre-incubation with thalidomide. However, superoxide anion release upon stimulation of the cells with phorbol-myristate-acetate or the chemotactic tripeptide N-f-Methionyl-Leucyl-Phenylalanine was enhanced in a dose-dependent manner after pre-incubation with thalidomide. Both PMNs and monocytes were influenced. Leukocytes from two patients with chronic granulomatous disease (defective in oxidative burst response) remained unable to produce superoxide anion after pre-incubation with thalidomide. Thus, we suggest that thalidomide primes the phagocytes to respond with an enhanced superoxide anion release upon stimulation. These findings do not explain the anti-inflammatory effect of thalidomide but could have relevance in conditions with quantitative defects in phagocyte oxidative responsiveness.

Chemotaxis↗

Chronic granulomatous disease associated with chronic glomerulonephritis.

A boy with chronic granulomatous disease (CGD) developed glomerulonephritis at the age of 12 years. The glomerulonephritis progressed to terminal uraemia at age 15 when maintenance haemodialysis was started. The clinical course was complicated by pulmonary aspergillosis and Pseudomonas septicaemia from which he eventually died. The glomerulonephritis was of unknown origin, and a possible relationship between CGD and glomerulonephritis is discussed.

Adolescent↗

Polymorphonuclear leucocytes defective in oxidative metabolism inhibit in vitro growth of Plasmodium falciparum. Evidence against an oxygen-dependent mechanism.

This report presents evidence that polymorphonuclear leucocytes (PMN) from chronic granulomatous disease (CGD) patients, who are defective in oxidative metabolism, are capable of inhibiting in vitro multiplication of Plasmodium falciparum. Using a microtitre in vitro inhibition assay, we incubated various numbers of peripheral blood neutrophils from CGD patients and from normal individuals with P. falciparum isolate F32 in the in vitro culture system. Inhibition of parasite growth by neutrophils was determined after 48 h of culture. At PMN to erythrocyte ratio of 1:50 there was an inhibition of parasite growth of 57% by normal neutrophils and 39% to 68% by CGD cells. When the neutrophils were stimulated by phorbol myristate acetate, both cell types enhanced inhibition of parasite growth. These findings indicate that the oxygen-independent systems of human neutrophils are involved in parasite destruction. Constituents of neutrophil granules such as acid hydrolases, lactoferrin, and cationic proteins could be regarded as potential mediators of parasite destruction.

Female↗

Interaction of human IgG preparations with polymorphonuclear leukocytes in vitro.

The effect of purified human immunoglobulin G, prepared for intravenous administration by polyethylene glycol precipitation and ion exchange chromatography, on polymorphonuclear leukocytes (PMN) in vitro was studied. IgG induced a dose-dependent stimulation of the oxidative metabolism of the cells, as measured by release of superoxide anion and by chemiluminescence. The lowest concentration giving a detectable effect was 0.001 mg/ml. Two commercially available preparations of IgG for clinical intravenous use caused similar stimulation of the PMN although they differ in methods of isolation and purification. The addition of 10% maltose markedly reduced the stimulation by all three preparations of IgG. We suggest that i.v. infusion of purified IgG may lead to activation in vivo of host phagocytic cells without participation of complement, and that this interaction may be responsible for the hitherto unexplained side-effects caused by i.v. infusion of such preparations.

Energy Metabolism↗

Interaction of Pseudomonas aeruginosa alkaline protease and elastase with human polymorphonuclear leukocytes in vitro.

Little is known about the interaction of Pseudomonas aeruginosa extracellular products and human polymorphonuclear leukocytes. The present study was designed to examine the effect of alkaline protease and elastase purified from P. aeruginosa on human neutrophil function. Neutrophil chemotaxis, oxygen consumption, glucose oxidation, superoxide production, and nitro blue tetrazolium reduction were studied. It was found that alkaline protease and elastase at fairly low concentrations (0.05 and 0.0025 micrograms/ml, respectively) inhibited chemotaxis. The inhibitory effect of both enzymes was increased at higher concentrations. The chemotaxis of preincubated and washed cells was also inhibited. Alkaline protease but not elastase inhibited opsonized zymosan-stimulated neutrophil oxygen consumption, whereas neither of the enzymes had any effect on glucose oxidation and nitro blue tetrazolium-reducing activity of stimulated neutrophils. The data on superoxide production ability of the cells indicated that the cells preincubated with enzyme and washed were capable of producing superoxide equal to the amount produced by untreated cells when they were stimulated with phorbol myristate acetate or zymosan. However, when elastase was present in the reaction mixture, the reduction of cytochrome c as a measure of superoxide production was inhibited. Inhibition of neutrophil function, particularly chemotaxis, will have important bearing on the escape of the microorganism from the phagocytic defense system of the host. The role of these products in localized infections and avascular areas such as skin burns, cornea, and, at least initially, in chronic lung colonization in cystic fibrosis patients becomes important.

Chemotaxis, Leukocyte↗

Pseudomonas aeruginosa exoproteases inhibit human neutrophil chemiluminescence.

The present study was designed to examine the effect of Pseudomonas aeruginosa alkaline protease and elastase on human polymorphonuclear leukocyte chemiluminescence. Both a luminol-enhanced and a nonenhanced chemiluminescence system using opsonized zymosan were utilized. It was found that alkaline protease and elastase at concentrations of 25 micrograms/ml strongly inhibited luminol-enhanced myeloperoxidase-mediated chemiluminescence, whereas inhibition of the nonenhanced chemiluminescence response was about 50%. In an attempt to determine the mechanism of inhibition of neutrophil chemiluminescence by these proteases, we examined the effect of various inhibitors of neutrophil oxidative metabolism on chemiluminescence, namely, superoxide dismutase, sodium azide, and catalase. It was shown that the pattern of inhibition of chemiluminescence by alkaline protease and elastase was similar to that of sodium azide, inhibitor of myeloperoxidase. The present study demonstrates that alkaline protease and elastase, extracellular products of P. aeruginosa, are capable of inhibiting myeloperoxidase-mediated chemiluminescence, one of the major antimicrobial systems of polymorphonuclear leukocytes. These findings provide further evidence for the role of P. aeruginosa exoproteases as virulence factors in the pathogenesis of infections caused by this microorganism.

Azides↗

Absence of cytochrome b-245 in chronic granulomatous disease. A multicenter European evaluation of its incidence and relevance.

The heme-containing protein cytochrome b-245 has been proposed as a primary component of the microbicidal oxidase system of phagocytes that normally generates superoxide-free radicals but when defective is associated with chronic granulomatous disease. We measured this cytochrome in granulocytes from 27 patients with chronic granulomatous disease and from 64 members of their families. It was undetectable in all 19 of the men in whom the defect appeared to be located on the X chromosome. Female relatives who were heterozygous carriers had reduced concentrations of the cytochrome and variable proportions of cells that were unable to generate superoxide; these two characteristics were closely related (r = 0.93 in the 16 mothers and 0.85 in all 24 carriers, P less than 0.001). In contrast, in all eight patients (seven women) with a probable autosomal recessive inheritance the cytochrome was present but nonfunctional. The properties tested, including midpoint potential, carbon monoxide binding, and organelle distribution, were normal, but the cytochrome did not undergo reduction on cellular stimulation. Thus, absence or malfunction of the cytochrome b-245 may be the causal molecular defect in chronic granulomatous disease, implicating it in the microbicidal oxidase system.

Adolescent↗

A variant form of X-linked chronic granulomatous disease with normal nitroblue tetrazolium slide test and cytochrome b.

Chronic granulomatous disease was diagnosed in a boy who suffered from severe generalized infections. Family investigations revealed the inheritance of the disease to be X-linked. However, unlike other cases of X-linked chronic granulomatous disease, the membrane oxidase of the neutrophils from this patient was not totally defective and sufficient activity was left to result in a normal phorbol myristate acetate-stimulated nitroblue tetrazolium slide test. Also, unlike the usual findings in X-linked chronic granulomatous disease, cytochrome b was present in normal amounts in the neutrophils from this patient. The cytochrome was normal, judged from its midpoint potential of -245 mV and its ability to bind CO. It is thus apparent that X-linked chronic granulomatous disease may result from at least two different defects and that the phorbol myristate acetate stimulated nitroblue tetrazolium slide test fails to detect some cases.

Adolescent↗

Defective neutrophil motility in patients with primary ciliary dyskinesia.

Microtubules are important in the regulation of the motile functions of a variety of cells, including leukocytes, ciliated cells and spermatozoa. Polymorphonuclear leukocyte function was studied in ten patients with primary ciliary dyskinesia, an inherited disorder of microtubules in sperm tails and cilia. Neutrophil chemotaxis in Boyden chambers was slightly reduced, but only one patient showed a migration below normal values. In vivo mobilization of polymorphonuclear leukocytes into skin windows was also slightly decreased. In contrast, neutrophil polarization and orientation was normal. The bactericidal activity of neutrophils from patients with primary ciliary dyskinesia was normal, while the ingestion of bacteria was decreased. The abnormalities of neutrophil function in patients with primary ciliary dyskinesia are related to motility. It is suggested that the microtubule defect responsible for the abnormal pattern of ciliary beating is a general abnormality also responsible for the depression of polymorphonuclear leukocyte motility.

Adolescent↗

Discoid lupus erythematosus and carrier status of X-linked chronic granulomatous disease.

Discoid lupus erythematosus (DLE)-like lesions and recurrent aphthous-like stomatitis have often been described in carriers of X-linked chronic granulomatous disease (CGD). The capacity of the polymorphonuclear leucocytes to reduce nitroblue tetrazolium (NBT) after stimulation with phorbol myristate acetate (NBT test), a function of normal oxidative metabolism, was determined in 34 patients with DLE of whom 17 also suffered from recurrent stomatitis. The NBT test turned out to be normal in all 34 patients, indicating that none of them were carriers of X-linked CGD. In spite of the negative results of this study it is recommended that all female patients suffering from DLE in combination with recurrent aphthous-like stomatitis are screened by means of the NBT test, because this examination is simple and inexpensive, and because of the importance of identifying carriers of CGD with a view to genetic guidance.

Adolescent↗

Chemotaxis, spreanding nd oxidative metabolism of neutrophils: influence of albumin in vitro.

Studies on polymorphonuclear leukocyte (PMN) migration in vitro have shown that albumin increases the speed of the cells without affecting their orientation, i. e. chemokinesis. In order to analyze this phenomenon the effect of albumin on PMN migration in a Boyden chamber towards various chemotactic agents was examined. On attraction with low molecular weight chemotactic factors (a culture filtrate of E. coli (BCF)) or the synthetic peptide N-Formyl-Methionyl-Leucyl-Phenylalanine (F-Met-Leu-Phe) albumin enhanced the migration of PMN. In contrast, albumin did not enhance the migration towards casein, a high molecular weight chemotactic factor, except at very low concentrations. In a direct visual assay, albumin was found to impair PMN spreading on a polystyrene Petri dish. In the presence of BCF or F-Met-Leu-Phe cell spreading remained inversely related to the concentration of albumin, while addition of casein again eliminated the influence of albumin. The effect of albumin on the interaction of PMN with a substrate was studied by measuring the superoxide anion (02-) release by PMN sedimenting on a micropore filter. The 02- release triggered by this stimulus of the PMN membrane was inversely correlated to the concentration of albumin. These results show that one mechanism of the enhancing effect of albumin on PMN migration is to diminish adhesion of the cells to the substratum, so that it remains reversible. It is suggested that the term chemokinesis is equivocal. The chemokinetic activity of chemotactic factors would be the result of specific stimulation of PMN locomotion. In contrast, the chemokinetic activity of albumin is due to changes of the physico-chemical environment which support PMN locomotion.

Caseins↗