A new sensitive microplate assay of plasma endotoxin

Difference in clearance of exogenously administered smooth-form LPS following host responses among normal, sensitized and LPS-tolerant mice

Clearance of exogenously administered Salmonella abortus equi LPS from the circulation following induction of host responses, e.g. release of soluble CD14 (sCD14) and TNFα production, were investigated. The endotoxin unit of administered LPS in plasma was monitored by a combined method. After 1 h, more than 80% of injected LPS disappeared from the circulation of normal mice at all doses except a 100 μg dose, but sCD14 in plasma could not yet be detected by Western blotting. Release of sCD14 reached a peak 9 h after LPS injection. According to pretreatment with either Propionibacterium acnes or silver nitrate, the clearance rates of exogenously added LPS from the circulation were accelerated in comparison with the rate in normal mice, but plasma TNF levels were the opposite. In LPS-tolerant mice, LPS clearance and production of TNF and sCD14 was reduced. Pretreatment with anti-CD14 mAb reduced LPS-induced TNF production but did not influence the clearance rates. Taken together, in vivo, sCD14 may not play a critical role for early LPS clearance.

Limulus amebocyte lysate (LAL) detection of endotoxin in human blood

Limulus amebocyte lysate (LAL) has been applied to the detection of endotoxin in human serum, plasma and blood since the early 1970s. Although the diagnostic potential of LAL for endotoxemia was recognized immediately, the assay's modest sensitivity and specificity (for Gram-negative sepsis/bacteremia) were perceived as limiting the clinical usefulness of LAL. In an attempt to overcome these drawbacks, many studies have been conducted since the initial work by Levin and his colleagues. Numerous attempts have been made to improve the sensitivity of the assay by changing the formulation of the LAL and assay methodology. The original gel-clot method has for the most part been replaced with turbidimetric or chromogenic methods. The amount of endotoxin detectable within a 1 h incubation period has gone from the nanogram to the picogram range. Since blood (plasma) components interfere with the test, various methods to remove inhibition and/or enhancement have been developed. The chloroform extraction technique of Levin and co-workers has been replaced with acid extraction or with dilution and heating. Partitioning of endotoxin in blood may also influence the assay (recovery). Many recent investigators use platelet-rich plasma instead of ordinary plasma, while a few studies have used whole blood. Even with all the improvements, the specificity and related diagnostic usefulness of the LAL assay for Gram-negative sepsis remain an obstacle for regulatory acceptance. This may have more to do with our understanding of the septic process than with the ability of LAL to detect endotoxin. Although a recent study indicates that the type of Gram-negative bacteremia may be a critical determinant for clinical utility of the LAL test, the presence of endotoxin is not highly predictive of Gram-negative sepsis and vice versa. However, with the potential availability of anti-endotoxin therapy, the diagnosis of endotoxemia, with or without bacteremia, may be extremely important for timely and effective treatment modalities. It is concluded that the LAL test and accompanying sample preparation has evolved into a clinically useful test for the detection of circulating endotoxins and even its modest predictability for sepsis may have some clinical utility.

Measurement of different types of endotoxin in murine plasma by pretreatment with alkaline reagent and kinetic chromogenic Limulus test

Using a combined pretreatment methodology employing an alkaline reagent and a kinetic chromogenic Limulus test using Endospecy®, different types of endotoxins in murine plasma were able to be measured quantitatively. The detection of smooth (S)-form Salmonella abortus equi LPS (S-LPS) was approximately twice as sensitive as Helicobacter pylori LPS in aqueous solution. S-LPS added to whole mouse blood was recovered quantitatively from plasma, but the rough (R)-form S. minnesota LPS was not. The rates of clearance of S-LPS from the circulation following intravenous injection were shown to be different among BALB/c, C3H/HeN and B10Sn mice. Infection of mice with Salmonella typhimurium 3 days earlier resulted in accelerated clearance of subsequently injected LPS from the circulation. Significantly higher amounts of free non-microbe-associated LPS were detected in the blood of mice 1 h after infection with Escherichia coli O111:B4 followed by immediate treatment with ceftazidime, in comparison with non-antibiotic-treated but infected mice.

Utilization of a chromogenic Limulus amebocyte lysate blood assay in a multi-center study of sepsis

We conducted a prospective study of a chromogenic LAL assay in 346 patients with sepsis syndrome, as defined by a modification of the Bone criteria, and 131 healthy volunteers at eight member centers of the Academic Medical College Consortium (AMCC). We identified patients with endotoxemia (> 0.40 EU/ml) by measuring LAL-reactive material in whole blood, extracted by the Tamura nitric acid method, with the chromogenic LAL (Pyrochrome®) assay. The mean result in sepsis patients with detectable endotoxemia (n = 241) was 1.07 ± 1.57 EU/ml, and the mean result in 131 volunteers was 0.151 ± 0.113 EU/ml, with 73% of the volunteers' results falling below the detectable limit. The average incidence of endotoxemia in sepsis patients was 33%, but varied 2.7-fold among the clinical centers (range 16-44%). Assay results were repeatable when samples tested frozen at the clinical sites were compared to results on frozen samples tested at Associates of Cape Cod, Inc. (ACC). Multiple samples were obtained from 40 patients at 18-24 h interval(s). Fourteen multidraw patients (35%) were endotoxemic at one or more draw(s) and eight of these patients had two or more draws with endotoxin levels > 1.0 EU/ml. The presence of sulfa drugs gave false positive results in two patient samples. A positive LAL test did not correlate with culture-proven bacterial infection and did not significantly correlate with mortality. There was a correlation ( P = 0.014) between a patient having a positive LAL test and the presence of a fungal infection when mixed fungal and bacterial infections were included. There was no correlation with a positive LAL test when only a fungal infection was present (P = 0.425) or when only a fungal and a Gram-positive infection was present ( P = 0.087).

Differential clearance and induction of host responses by various administered or released lipopolysaccharides

The clearance and activity of different types of lipopolysaccharide (LPS) released during infection with Gram-negative bacteria were investigated. When highly purified preparations differing in their specific endotoxin activity were administered intravenously to mice, the clearance of rough (R)-form LPS preparations from Salmonella minnesota and Escherichia coli was much faster than that of a smooth (S)-form LPS preparation from Salmonella abortus equi, but slower than that of lipooligosaccharides (LOS) preparations from Bordetella pertussis and Helicobacter pylori. After intraperitoneal infection with 107and 108CFU E. coli O111:B4, relatively high levels of LPS were detected dose-dependently in the plasma of infected mice and persisted for a long time. In addition, plasma sCD14 levels in infected mice were higher than in LPS-administered mice. These results indicate that continuously higher levels of plasma LPS followed by stronger host responses occur during infection and suggest that these differences between LPS-administered and infected mice should be taken into consideration when analyzing host responses induced by LPS.

Antibiotic microbial assay using kinetic-reading microplate system

The aim of this study was to determine the optimal experimental conditions to develop a methodology for microbiological assay of apramycin employing microplate and kinetic reading mode, and to validate the developed method, through evaluation of parameters of selectivity, linearity, linear range, limits of detection and quantification, accuracy and precision. The turbidimetric assay principle is simple: the test solution is added to a suspension of test microorganism in culture media, the mixture is incubated under appropriate conditions and the microbial growth is measured by photometric reading. Microplate with kinetic reading mode employed in antibiotic assay is of considerable interest since it allows reduction of material and analysis time and enables a large number of samples to be analyzed simultaneously, with automated reading and calculating. Established conditions considered the standard-curve of apramycin at concentrations from 5.0 to 35.0 μg mL-1, and tryptic soy broth inoculated with 5% Escherichia coli (ATCC 8739) suspension. Satisfactory results were obtained with 2 hours of incubation. The developed method showed appropriate selectivity, linearity in the range from 5.0 to 35.0 μg mL-1, limits of detection and quantification of 0.1 and 0.4 μg mL-1, respectively, as well as satisfactory accuracy (recuperation = 98.5%) and precision (RSD = 6.0%). Microplate assay combined the characteristics of microbiological (evaluation of antibiotic activity against sensitive test microorganism) and physico-chemical (operationally straightforward and faster results) assays.

Non–Culture-Based Diagnostics for Opportunistic Fungi

The value of the diagnostic markers galactomannan and 1,3-beta-D-glucan for the diagnosis of opportunistic fungal infections is reviewed in this article. Both markers have undergone clinical evaluation, and increasing insight is emerging with respect to the causes of false-negative or false-positive reactivity. These data will help design protocols in which single or multiple markers are used to identify patients who require antifungal therapy.

Long-term ethanol feeding enhances susceptibility of the liver to orally administered lipopolysaccharides in rats

BACKGROUND

Endotoxin has been implicated in the pathogenesis and progression of alcoholic liver disease. However, it is still unclear how long-term ethanol feeding affects absorption of endotoxin from the intestine and susceptibility of the liver to gut-derived endotoxin. The object of this study was to determine the effect of long-term ethanol feeding on hepatic susceptibility to orally administered endotoxin.

METHODS

Male Wistar rats that weighed approximately 150 g were pair-fed with an ethanol-containing liquid diet or a control diet for 35 days. In some experiments, 0, 10, or 20 mg/kg of lipopolysaccharides (LPS) was added to the liquid diet for 7 days beginning on day 29. On day 36, the animals were killed for blood biochemistry and histologic examination of the liver. We also determined plasma endotoxin levels after 20 mg/kg of LPS administration using a gastric tube. In another set of experiments, we determined intestinal permeability using FD4 (fluorescein isothiocyanate-labeled dextran with an average molecular weight of 4000 D).

RESULTS

With 10 mg/kg of LPS, serum alanine aminotransferase (ALT) and alkaline phosphatase (ALP) levels were significantly increased in the ethanol-fed rats but not in controls. After 20 mg/kg of LPS administration, more substantial increases in serum ALT and ALP levels were observed in ethanol-fed rats as compared with control diet-fed rats. Plasma endotoxin levels in long-term ethanol-fed rats were higher than those in control rats after intragastric administration of high-dose endotoxin (20 mg/kg). Furthermore, intestinal permeability to FD4 was increased by long-term ethanol administration.

CONCLUSIONS

Long-term ethanol feeding increases intestinal permeability to and absorption of endotoxin, which can sequentially enhance hepatic susceptibility to orally administered endotoxin. This model has potential as a subclinical experimental model for the study of alcoholic liver disease.

Effect of acute ethanol administration on the intestinal absorption of endotoxin in rats

BACKGROUND

Endotoxin has been implicated in the pathogenesis and progression of alcoholic liver disease. Not only inactivation of reticuloendothelial function, which reduces clearance of endotoxin, but also an increase in absorption of endotoxin from the intestine may be involved in mechanisms of ethanol-induced endotoxemia. However, it is unclear how ethanol affects absorption of endotoxin from the intestine in vivo.

METHODS

We gave 10 mg/kg of lipopolysaccharides to rats with water (group 1), 5% ethanol (group 2), or 20% ethanol (group 3) using an intubation tube to the stomach. Blood samples were collected and plasma endotoxin levels were measured. We used fluorescence spectrophotometer to examine permeability of the gut to macromolecules (fluorescein isothiocyanate-dextran; 4,000 Da [FD4] or 20,000 Da [FD20]).

RESULTS

Plasma endotoxin levels were not different between group 1 (9 +/- 2 pg/ml) and group 2 (14 +/-3 pg/ml), whereas they significantly increased in group 3 with a peak at 60 min (87 +/- 35 pg/ml). Acute ethanol administration did not affect clearance of endotoxin in rats. Hemorrhagic erosions of the proximal small intestine with epithelial cell loss were observed in group 3 at 4 hr, but no significant histological change was observed at 30 min by light microscopy. Acute ethanol administration (20%) increased the permeability of the small intestine to FD4 and FD20 in 30 min when no hemorrhagic erosions of the proximal small intestine with epithelial cell loss were observed.

CONCLUSIONS

Acute ethanol administration increases intestinal permeability before pathological changes are revealed by light microscopy. Acute ethanol ingestion, especially at high concentrations, facilitates the absorption of endotoxin from rats' small intestine via an increase in intestinal permeability, which may play an important role in endotoxemia observed in alcoholic liver injury.

Correlation between the serum level of endotoxin and periventricular leukomalacia in preterm infants

The objective of our study was to determine the relation between the serum level of endotoxin at birth and the development of periventricular leukomalacia (PVL) in preterm infants. We studied 68 preterm infants whose gestational ages ranged between 27 and 33 weeks, and birthweights between 1000 and 2000 g. The serum endotoxin level was measured in the blood immediately after birth by means of a conventional chromogenic Limulus test. Serum endotoxin was taken as present when it was >5 pg/ml (indicated by ENDO(+)). Premature rupture of membranes (PROM), the mode of delivery, EEG findings and the development of PVL were investigated. Six infants were diagnosed as having cystic PVL on ultrasonography. Endotoxin was detected in 28 infants. PROM was observed in 18 ENDO(+) infants and 16 ENDO(-) infants (P = 0.085). Caesarean section was performed in nine ENDO(+) infants and 14 ENDO(-) infants (P = 0.29). PVL was observed in two ENDO(+) infants and four ENDO(-) infants (P > 0.99). EEG abnormalities were recognized in five ENDO(+) infants and six ENDO(-) infants (P > 0.99). Between ENDO(+) infants and ENDO(-) infants, no significant difference was observed in any of the four parameters. These results may indicate that endotoxin itself does not directly cause PVL.

Activation of transcription factors and IL-8 expression in neutrophils stimulated with lipopolysaccharide from Porphyromonas gingivalis

DNA binding activity of NF-kappa B and AP-1 were examined in neutrophils stimulated with LPS purified from P. gingivalis, a major pathogenic bacteria of periodontitis lesion. Porphyromonas gingivalis LPS enhanced the activity reaching a peak at a concentration of 500 ng/ml in the absence of serum. The NF-kappa B activation stimulated with 10 ng/ml of P. gingivalis LPS was suppressed approximately 44% by treatment of neutrophils with anti-CD14 antibody under the presence of serum. Increase in the steady-state IL-8 mRNA level was concomitantly observed by stimulation of neutrophils with 500 ng/ml of P. gingivalis LPS under the absence of serum. These results indicate that P. gingivalis LPS activates NF-kappa B and AP-1 in both serum-dependent and -independent manners, followed by increased IL-8 transcription in neutrophils, and suggested a role for P. gingivalis LPS in IL-8 synthesis by neutrophils in inflamed gingiva and GCF.

Immunohistopathological characterization of pig pneumonia caused by a combined Aujeszky's disease virus and Actinobacillus pleuropneumoniae infection

Nine pigs were inoculated endobronchially with Actinobacillus pleuropneumoniae serotype 1 (App-1) 6 days after infection with Aujeszky's disease virus (ADV); four died within 3 days and the remainder were killed after 1-6 days. Immunohistopathologically, there were two types of pneumonic lesion: pleuropneumonia, characterized by coagulative necrosis, oedema and fibrinous thrombosis; and necrotizing interstitial pneumonia, characterized by bronchitis, bronchiolitis and alveolitis. The former type of lesion was associated with App-1 antigen, and the latter with ADV antigen. These results indicated that a combined ADV and App-1 infection produced severe haemorrhagic pleuropneumonia; and that ADV and App-1 each produced a characteristic pneumonic lesion.

Hemodynamic and metabolic effects of vasopressin blockade in endotoxin shock

BACKGROUND

Arginine vasopressin V1 receptor antagonist (AVPRA) was administered to investigate the influence of vasopressin blockade on hemodynamics and metabolism during endotoxin shock.

METHODS

Anesthetized rats were divided into four groups: control (0.9% saline solution, n = 5), drug control (AVPRA, n = 5), endotoxin (endotoxin, 5 mg/kg, n = 10), and pretreatment (AVPRA and endotoxin, n = 10). Hemodynamics and oxygen transport were evaluated for 2 hours. Terminal arterial and portal venous concentrations of endotoxin, pyruvate, lactate, and ketone bodies were determined.

RESULTS

The endotoxin group maintained blood pressure levels similar to those of control animals. AVPRA pretreatment decreased vascular resistance and resulted in lower blood pressure than endotoxin alone. Endotoxin decreased oxygen consumption and the oxygen extraction ratio and increased arterial lactate concentration and the lactate/pyruvate ratio. Endotoxin also decreased arterial ketone body concentration and markedly decreased ketone body availability in the mesenteric circulation. AVPRA pretreatment improved oxygen consumption, oxygen extraction ratio, and ketone body availability; arterial lactate concentration, lactate/pyruvate ratio, and arterial ketone body concentration were not affected. Pretreatment with AVPRA also decreased arterial and portal venous concentrations of endotoxin.

CONCLUSIONS

Vasopressin receptor blockade during endotoxemia resulted in lower blood pressure than endotoxin alone. Vasopressin receptor blockade also maintained oxygen extraction ratio and ketone body availability in the mesenteric circulation. Vasopressin may play a key role in the response to endotoxemia.