Lung injury and lung lysosomal enzyme release during endotoxemia

Natural and endotoxin-induced atresia of preantral and early antral follicles is characterized by DNA internucleosomal cleavage

Preantral follicles (PAF) and early antral follicles (EAF) were isolated from bovine ovaries and classified under a stereomicroscope as atretic or healthy. The atretic follicles were all considered as group I (in vivo atresia), whereas healthy follicles were assigned to five groups (group II, in vivo normal control; group III, in vitro normal control; group IV, in vitro induced atresia; groups V and VI, Lipopolysaccharide (LPS)-induced atresia in vitro). Group I and II follicles were immediately snap-frozen (-70 degrees C) until DNA extraction, whereas group III-VI follicles were incubated (39 degrees C, 5% CO2, 95% air) for periods up to 72 hr under various conditions. Group III follicles were maintained in complete medium (M199, bovine calf serum, sodium pyruvate, epidermal growth factor, insulin, transferrin, sodium selenite, penicillin, streptomycin, and amphotericin), whereas group IV follicles were incubated in the same medium, but without serum. Group V and VI follicles were maintained in complete medium, but in the presence of LPS (10 or 50 micrograms/ml, respectively). Results showed that follicles incubated in the absence of serum and those exposed to both doses of LPS became atretic. DNA isolated from all atretic follicles showed fragmentation typical of that described for apoptosis; this was also confirmed by in situ DNA labeling and histology. Atretic follicles did not produce estradiol (P < 0.001), but progesterone values increased with follicle size (P < 0.001) and time of incubation (P < 0.001). We concluded that in the absence of serum or in the presence of LPS, follicles undergo atresia via apoptosis.

Disseminated intravascular coagulation

This review encompasses a description of the main pathophysiological events leading to disseminated intravascular coagulation (DIC). Emphasis has been put on microcirculatory disturbances and endothelial dysfunction. The normal hemostatic functions of the vascular endothelium are described. The close connection between endothelium and superimposed immuno-modulators is stressed as is the interrelation between the proteolytic cascade systems in the blood. The importance of differentiating local and systemic events is discussed. Organ dysfunction in multiple organ failure (MOF) is exemplified by pulmonary insufficiency in the adult respiratory distress syndrome (ARDS). Essential laboratory tests of DIC are described as are the cornerstones of treatment.

Platelet-activating factor in porcine Pseudomonas acute lung injury

We investigated the role of platelet-activating factor (PAF) in acute septic lung injury by examining the effects of the selective PAF antagonist SRI 63-675 and by measuring PAF in lung tissue in the porcine model. Four groups of pigs (15-25 kg) were studied: saline control (C, n = 5); Pseudomonas (Ps, n = 9), given 5 x 10(8) CFU/ml at 0.3 ml/20 kg/min intravenously over 1 hr; SRI (n = 3), given SRI 63-675 in a 40 mg/kg bolus; and SRI + Ps (n = 5). Ps infusion produced a fulminant lung injury characterized by a threefold increase in pulmonary arterial pressure at 30 min and persistent pulmonary hypertension (P less than 0.05 vs C), a significant (P less than 0.05 vs C) decrease in arterial oxygen tension (PaO2) from 60 min, a significant (P less than 0.05 vs C) increase in extravascular lung water (EVLW) from 120 min, and a significant (P less than 0.05 vs C) increase in albumin flux determined scintigraphically as slope index at 150-180 min. Systemic arterial pressure and cardiac index (CI) decreased significantly (P less than 0.05) in the Ps group vs C at 60 and 180 min, respectively. Bolus injection of SRI 63-675 at the time of Ps infusion blocked the early pulmonary hypertension, attenuated the early and late fall in PaO2, ameliorated the increase in EVLW, and prevented the late (150-180 min) increase in albumin flux. SRI 63-675 had minimal effects on Ps-induced hypotension or alterations in CI.(ABSTRACT TRUNCATED AT 250 WORDS)

Endotoxic shock. Part I: A review of causes

Endotoxic shock is a complex phenomenon resulting from systemic release of inflammatory mediators. Endotoxin interacts with inflammatory cells, platelets, and vascular endothelium. Cytokines, such as tumor necrosis factor and interleukins, and lipid mediators (platelet activating factor, thromboxane, prostacyclin, leukotrienes) are released. These primary mediators act synergistically to cause many of the harmful effects associated with endotoxemia. Multiple secondary mediators are released in response to the primary mediators, compounding the damage. The end result is the species-specific clinical syndrome recognized as endotoxemia.

Extracorporeal membrane oxygenation therapy in neonates with septic shock

Neonatal septic shock has significant morbidity and mortality with current therapeutic measures. At Children's National Medical Center, from June 1984 to October 1986, 10 of 100 patients treated with venoarterial extracorporeal membrane oxygenation (ECMO) had a documented diagnosis of septic shock. All of these infants fulfilled criteria consistent with 80% mortality using conventional intensive medical management. However, the survival rate for the septic neonates in this study was 100%. Compared with other groups of infants treated with ECMO, these septic neonates required significantly more ventilatory support after ECMO and had a higher incidence of chronic lung disease (30% v 12%). The septic neonates were also at higher risk for intracranial hemorrhage than the other infants treated with ECMO (40% v 26%). The necessity for prolonged intubation after ECMO for patients with septic shock suggests that this condition may be associated with additional structural damage not seen with meconium aspiration syndrome or respiratory distress syndrome. Nevertheless, for neonatal patients with septic shock unresponsive to conventional medical management, ECMO must be considered a viable alternative treatment.

Physiology of the potentiation of lethal endotoxin shock by streptococcal pyrogenic exotoxin in rabbits

Streptococcal pyrogenic exotoxin (SPE) dramatically potentiates the lethal shock induced by gram-negative bacterial endotoxin. To provide further understanding of the mechanism underlying the potentiating effect, the physiological basis for the toxic synergism of the two toxins was investigated. Pretreatment of rabbits with an intravenous (i.v.) dose (10 micrograms/kg of body weight) of SPE greatly enhanced the endotoxin lethality and reduced the 50% lethal dose to less than 5 micrograms of endotoxin per kg. The SPE pretreatment dose caused severe pathophysiological changes in combination with a small i.v. dose of endotoxin (1 microgram/kg). These changes included transient hyperglycemia followed by profound hypoglycemia, elevation of the blood lipoperoxide level, and an acute increase in plasma beta-glucuronidase activity. These changes were comparable with those in animals given a large i.v. dose of endotoxin (100 micrograms/kg) alone. An injection of SPE alone did not alter any of the parameters described above. These results suggest that SPE renders rabbits more sensitive to extensive pathophysiologic effects of endotoxin, and the potentiating effect on endotoxin lethality may thus involve a general potentiation of physiologic failures. The SPE pretreatment depressed the vascular clearance of a large dose of endotoxin (100 micrograms/kg) but failed to affect that of a small dose of endotoxin (1 microgram/kg). The data suggest that the potentiating effect is not readily explained solely on the basis of the decreased clearance of endotoxin.

Lipid X ameliorates pulmonary hypertension and protects sheep from death due to endotoxin

Lipid X (2,3-diacylglucosamine-1-phosphate) is a novel monosaccharide precursor of lipid A that has some of the physiologic activities of endotoxin but little toxicity. To determine whether lipid X would interfere with the toxic effects of endotoxin, we pretreated sheep with either 100 or 200 micrograms of lipid X per kg of body weight and then challenged them with a potentially fatal dose of Escherichia coli endotoxin (20 micrograms/kg). Twenty-one sheep underwent pulmonary artery catheterization and were monitored for changes in pulmonary artery pressure, temperature, pH, partial O2 pressure, partial CO2 pressure, blood pressure, and cell counts over 7 h. Overall mortality for control animals was 37% versus 5.3% for pretreated animals. None of the 13 animals pretreated with 100 micrograms of lipid X per kg died. These differences in survival were significant (P less than 0.05). Animals pretreated with 100 micrograms of lipid X per kg had significantly lower pulmonary artery pressure during both phases 1 and 2 of endotoxin-induced pulmonary artery hypertension. A higher dose of lipid X, 200 micrograms/kg, produced pulmonary hypertension. Perhaps because lipid X is a subunit of lipid A, lipid X shows a partial pyrogenic effect while also decreasing the pyrogenic activity of complete lipopolysaccharide (LPS). Lipid X did not prevent endotoxin-induced neutropenia or moderate hypotension in response to LPS. Lipid X is a potential prototype compound for a new type of chemotherapy directed at blocking the harmful effects of LPS during bacterial septicemia.

Lysosomal enzyme pattern in lung lymph and blood during E. coli sepsis in sheep

Systemic release of lysosomal enzymes and local release in the pulmonary microcirculation from sequestrated and activated leucocytes could be an important factor in the development of the lung microvascular injury seen after septicaemia. The maximal activities of 11 lysosomal acid hydrolases (acid phosphatase, alpha- and beta-glucosidase, alpha- and beta-galactosidase, alpha-mannosidase, beta-acetylglucosaminidase, beta-glucuronidase, arylamidase and cathepsins B and C) were measured in serum and lung lymph from seven sheep before and after infusion of live E. coli bacteria. In the early phase of septicaemia (the first hour) the activities of eight enzymes were increased in serum and/or lung lymph (1.1 to 2X pre-infusion values). In the late phase, 3-4 h after sepsis, there were significantly elevated serum activities of beta-glucosidase (5.4X), alpha- and beta-galactosidases (2.7X, 1.5X), beta-acetylglucosaminidase (2.0X) arylamidase (1.2X) and cathespin B (1.7X). In lymph acid phosphatase (1.7X), alpha- and beta-glucosidases (1.6X, 6.4X), alpha- and beta-galactosidases (2.1X, 1.7X). Beta-acetylglucosaminidase (2.6X), and beta-glucuronidase (4.0X pre-infusion) were elevated. The findings of a heterogenicity of changes in serum and lymph activities, as well as the large molecular sizes of some of the enzymes with changed activities indicated to us that permeability changes were not major causes of increased lymph enzyme activities. The results could indicate a local release of enzymes either from sequestrated leucocytes or lung tissue due to local reactions in the lung or lung microvessels. The heterogenous changes in activities for the various lysosomal enzymes as found in the present study indicated that measurement of only one enzyme could be misleading.(ABSTRACT TRUNCATED AT 250 WORDS)

Current perspectives on septic shock

Although septic shock may be initiated by invading microbes, it is the metabolic and immunologic host responses that determine the true pathophysiology of this common critical care illness. Currently, septic shock therapeutics emphasize empiric and symptomatic treatment. Biochemical elucidation of the septic process will ultimately result in specific interventions for this ominous intensive care syndrome.

Activation and inhibition of Limulus amebocyte lysate coagulation by chemically defined substructures of lipid A

Recent work with lipid mutants of Escherichia coli and Salmonella typhimurium has helped to elucidate the correct structure of lipid A and has suggested a biosynthetic pathway. Precursor molecules include diacylglucosamine 1-phosphates and tetraacyl disaccharide bis-phosphates. The activities of several of these compounds and of their derivatives were measured by Limulus amebocyte lysate (LAL) assay. We report that (i) both mono- and disaccharide precursors of lipid A activate LAL, (ii) two acyl chains on the monosaccharide subunit of lipid A are necessary for activation of LAL, and (iii) the monosaccharide, 2-monoacylglucosamine 1-phosphate can competitively inhibit LAL activation by diacyl monosaccharide lipid A precursors. However, 2-monoacylglucosamine 1-phosphate did not inhibit endotoxin activation of LAL. One unanticipated finding was that the activities of the monosaccharides were reduced upon storage even though their covalent structures were unchanged. Perhaps this is due to alterations in physical state. Thus, these lipid A precursors and derivatives offer some insight into the structural features required for activation of the LAL assay and may in the future provide derivatives which are competitive inhibitors of endotoxin.

Lysosomal hydrolases in neutrophils, mononuclear cells and serum during Escherichia coli endotoxinaemia in pigs

The appearance of 10 different lysosomal enzymes in leucocytes and serum were studied during various stages of Escherichia coli endotoxinaemia in pigs. The animals were monitored in halothane anaesthesia and ventilated with a mechanical ventilator. The endotoxin infusion induced a marked increase in pulmonary artery pressure while the systemic blood pressure was significantly lowered. A pronounced decline in circulating leucocytes occurred. There was a general trend of intracellular reduction of lysosomal enzymes in both PMN and mononuclear cells, whereas increasing serum levels of the same enzymes occurred. Significantly higher serum levels of all lysosomal enzymes were found 5 h after start of endotoxin infusion compared to preinfusion values, while a significant acidosis in the aorta blood was registered. These results indicate that lysosomal enzymes are released from white blood cells following endotoxin stimulation. When local pH values allow enzyme activity, they may contribute to the tissue destruction seen in endotoxinaemia.

Plasma acid phosphatase levels in endotoxaemia: modification by drugs and chemically detoxified endotoxins

The ability of chemically detoxified E. coli endotoxins and membrane-active agents to modify the toxicity of native E. coli endotoxin in vivo was examined. The time- and dose-dependent increase in plasma acid phosphatase activity following toxin administration to rats provided a convenient quantitative measure of in vivo toxicity under various experimental conditions. Treatment of endotoxin with either sodium hydroxide or sodium periodate produced substances which, when injected alone, failed to cause an increase in plasma acid phosphatase activity. When given before native endotoxin, periodate-detoxified toxin produced a dose-dependent reduction in the elevation of plasma enzyme activity caused by unmodified toxin. Pretreatment with pranolium, hydrocortisone or (+)-propranolol also reduced the in vivo toxicity of endotoxin. Mortality studies in mice provided further independent support for the effectiveness of periodate-detoxified endotoxin and membrane-active drugs as endotoxin antagonists. Evidence has been found that under certain conditions gentamicin may act synergistically with bacterial endotoxins in vivo.