Detection of a common mutation in factor V gene responsible for resistance to activate protein C causing predisposition to thrombosis

Hereditary predisposition to thrombosis due to activated protein C resistance (APCR) has been attributed to a missense mutation in the factor V gene at nucleotide 1691 (G to A), causing replacement of arginine at codon 506 with glutamine. Using an RFLP-PCR assay to detect this mutation, we measured a prevalence of 3.3% in healthy Caucasians and 1.25% in healthy African-Americans. In addition, we evaluated a total of 90 consecutive specimens submitted to the coagulation laboratory at the Medical College of Virginia for the presence of this mutation. We compared our results for 78 of these specimens with the values measured by a modified partial thromboplastin assay, the COATEST. Twelve of the 90 samples could not be tested using the COATEST because the patients were undergoing anticoagulant therapy. One of the latter 12 specimens was positive by the RFLP-PCR test. Using the genetic test as the definitive assay and the cutoff value established for distinguishing between normal and abnormal results by the COATEST, the COATEST had a sensitivity of 50% and specificity of 93% for the detection of factor V mutation. Analysis of the 90 samples stratified by ethnic groups revealed a frequency of mutation of 13.3% for Caucasians and 6.88% for African-Americans, although with the present sample size, the difference was not statistically significant. Although the COATEST is technically simpler to perform than the genetic test for diagnosing the presence of the factor V mutation, its use for this purpose is limited due to low sensitivity. Thus where this disorder is clinically suspected, submission of the specimen directly for genetic testing by RFLP-PCR or equivalent assay should be considered.

Morphologic and functional characteristics of alveolar macrophages following cryopreservation

Cryopreservation of nucleated blood and bone marrow mononuclear cells has been used both to preserve such cells for clinical, diagnostic, or research use and to eliminate them as passengers in frozen tissue destined for transplantation. Although techniques for macrophage and monocyte cryopreservation have been described, little work has been done on the functional state of these cells following frozen storage. Using rabbit alveolar macrophages (AM), we have shown that AM can be frozen, stored, and recovered without morphologic changes. Furthermore, freshly isolated and cryopreserved AM do not differ in their adherence characteristics or the organization of their actin cytoskeleton. Cryopreserved normal AM also retained inducible functions such as superoxide anion (O2-) release and production of tumor necrosis factor (TNF) and interleukin-1 (IL-1). In order to further define the effects of cryopreservation on macrophage biology, we have also frozen macrophages which have been primed in vitro, and have demonstrated that the primed state remains at prefreezing levels after thawing and subsequent analysis. These data help define the effects of cryopreservation on cell function and establish parameters for the clinical and experimental evaluation of cryopreserved mononuclear phagocytes.

Relationships between pulmonary inflammation, plasma transudation, and oxygen metabolite secretion by alveolar macrophages

We have previously shown that alveolar macrophages from normal rabbit lungs do not synthesize reactive oxygen intermediates unless first conditioned by culture in vitro in the presence of serum for 24 to 48 hr. This conditioning process is mediated by a serum constituent that partitions on gel exclusion columns with an apparent m.w. of 30,000 to 50,000 daltons. Alveolar macrophage conditioning in vitro requires protein synthesis, is associated with the generation of membrane NADPH oxidase activity, and is reversible. We have predicted therefore that during the course of pulmonary inflammation, as observed 3 wk after i.v. injection of M. butyricum in oil, alveolar macrophages might similarly become conditioned in vivo through exposure to plasma protein transudates reaching the alveolus. In support of this hypothesis we show that after experimental production of granulomatous pulmonary inflammation in rabbits, alveolar macrophages showed an augmented capacity to secrete superoxide anion when stimulated with phorbol ester, and this enhancement increases exponentially with increased plasma transudation. This augmented enhancement was reversible, and decreased after culture in vitro in the absence of serum. Mature alveolar macrophages were responsible for this enhanced superoxide anion production rather than freshly emigrated monocytes. Moreover, superoxide anion production in this model of pulmonary inflammation appears to be an "all-or-none" phenomenon, with superoxide anion production associated with a subpopulation of optimally conditioned alveolar macrophages, whereas the remaining unconditioned alveolar macrophages produce little or none. We feel that these two classes of alveolar macrophages may be derived from inflamed and noninflamed regions of the lung, respectively, thereby reflecting the discontinuous nature of the inflammatory lesions themselves. Thus we propose that measurements of reactive oxygen intermediate production by lavaged alveolar macrophages may provide a semi-quantitative measure of chronic pulmonary inflammation.

Relationships between pulmonary inflammation, plasma transudation, and oxygen metabolite secretion by alveolar macrophages

We have previously shown that alveolar macrophages from normal rabbit lungs do not synthesize reactive oxygen intermediates unless first conditioned by culture in vitro in the presence of serum for 24 to 48 hr. This conditioning process is mediated by a serum constituent that partitions on gel exclusion columns with an apparent m.w. of 30,000 to 50,000 daltons. Alveolar macrophage conditioning in vitro requires protein synthesis, is associated with the generation of membrane NADPH oxidase activity, and is reversible. We have predicted therefore that during the course of pulmonary inflammation, as observed 3 wk after i.v. injection of M. butyricum in oil, alveolar macrophages might similarly become conditioned in vivo through exposure to plasma protein transudates reaching the alveolus. In support of this hypothesis we show that after experimental production of granulomatous pulmonary inflammation in rabbits, alveolar macrophages showed an augmented capacity to secrete superoxide anion when stimulated with phorbol ester, and this enhancement increases exponentially with increased plasma transudation. This augmented enhancement was reversible, and decreased after culture in vitro in the absence of serum. Mature alveolar macrophages were responsible for this enhanced superoxide anion production rather than freshly emigrated monocytes. Moreover, superoxide anion production in this model of pulmonary inflammation appears to be an "all-or-none" phenomenon, with superoxide anion production associated with a subpopulation of optimally conditioned alveolar macrophages, whereas the remaining unconditioned alveolar macrophages produce little or none. We feel that these two classes of alveolar macrophages may be derived from inflamed and noninflamed regions of the lung, respectively, thereby reflecting the discontinuous nature of the inflammatory lesions themselves. Thus we propose that measurements of reactive oxygen intermediate production by lavaged alveolar macrophages may provide a semi-quantitative measure of chronic pulmonary inflammation.

Serum factor requirement for reactive oxygen intermediate release by rabbit alveolar macrophages

Alveolar macrophages (AM) from pathogen-free rabbits were unable to release reactive oxygen intermediates (ROI) unless they were conditioned in serum for 24-48 h before triggering with membrane-active agents. The degree of serum conditioning of AM depended upon the concentration of serum used; optimal ROI release was obtained at or above 7.5% fetal bovine serum (FBS). FBS, autologous rabbit serum, pooled rabbit serum, and pooled human serum were each capable of conditioning AM for release of ROI. Serum conditioning of AM requires synthesis of new protein(s); and the enzyme required for ROI production, NADPH oxidase, was only detectable in serum-conditioned cells. Moreover, serum-conditioned cells lost their ability to release ROI after transfer to serum-free medium, while cells maintained in serum-free medium acquired the capacity to release ROI after their transfer to serum-containing medium, demonstrating the reversibility of the phenomenon. Initial purification data indicate that conditioning is mediated by a discrete serum constituent, which precipitates 40-80% saturated ammonium sulfate, does not bind to Cibacron Blue columns, and has a molecular weight of 30,000 to 50,000, as determined by molecular exclusion chromatography. Unlike gamma interferon, which also enhances ROI release by macrophages, our serum-conditioning factor is not acid labile, retaining 67% of its activity after 120 min incubation at pH 2.0. Moreover, it does not appear to be a contaminating endotoxin, since LPS neither conditioned AM for ROI production, nor triggered ROI production by serum-conditioned AM. We propose that such a conditioning requirement may normally protect the lung against ROI-mediated tissue injury. However, during a pulmonary inflammatory reaction initiated by other mediator systems, the resulting transudation of plasma proteins into the alveolar spaces may condition AM in situ for ROI production.

Immunologic mechanisms of parenchymal lung injury

The lung, like most other organs, is susceptible to injury by circulating immune complexes, and also by humoral autoantibody and immune lymphocytes which specifically recognize selected lung antigens. In addition, by virtue of its direct communication with the external environment, the lung can also be injured by inhaled environmental agents which trigger inflammatory reactions mediated by immune effector systems. Although major emphasis to date has been placed on the ability of inhaled antigens to first sensitize, then provoke, immunologically specific reactions in the lung, there is increasing evidence to show that these same immune effector systems are also triggered in an immunologically nonspecific fashion by a certain environmental agents (termed "mitogens") which activate leukocytes in a polyclonal fashion. Such agents include certain viruses and other microorganisms, bacterial endotoxin, a wide variety of plant lectins, and certain chemicals, such as the phorbol esters. Although such agents act in an immunologically nonspecific fashion, they are nonetheless quite specific from a chemical viewpoint, and in many cases act by binding to specific receptors on the cell surface. By activating macrophages directly, and by activating much larger percentages of a given lymphocyte population than do specific antigens, they induce correspondingly amplified inflammatory reactions in vivo. Recent studies with animal models indicate that inhaled mitogens are strikingly effective in inducing pulmonary inflammation, whereas inhaled antigens (lacking mitogenic activity) produce little if any parenchymal injury in immunized recipients, unless administered in conjunction with a mitogen. Ongoing studies using such models promise to provide valuable new insight into the biologic properties which govern the pathogenicity of inhaled environmental agents, the mediators they release, and the biochemical basis for variations in individual susceptibility to injury by such agents.

Two mechanisms of cell-mediated cytotoxicity: Ca++ transport modulation by lymphotoxin and transmembrane channel formation by antibody and nonadherent spleen cells

Lymphotoxin is a protein with a MW of 45,000 daltons derived from activated lymphocytes that kills target cells nonspecifically. Kinetic studies indicate that there is a lag period of about 4 hours before cytotoxicity becomes apparent, even at high concentrations of lymphotoxin. Therefore, the role of lymphotoxin in cell-mediated cytotoxicity would be restricted to situations in which more rapid mechanisms are not operative. It has found that lymphotoxin increases the rate of 45Ca++ uptake by the mouse L-cells used as targets. This effect and the cytotoxicity are abrogated by ouabain. A lymphotoxin-resistent L-cell mutant did not display the 45Ca++ uptake effect. It is not known whether the Ca++ effect is primary or secondary. Neutralization experiments with anti-lymphotoxin have indicated that there are at least two distinct pathways by which immune lymphocytes can destroy target cells in vitro--one that involves secretion of a nonspecific soluble factor, i.e., lymphotoxin, and another that probably requires intimate contact between the plasma membranes of the target and killer cells. This "membrane contact" mechanism may involve formation of channels in the target cell membranes. The transmembrane channel concept is a working hypothesis that is based on experiments by Henkart and Blumenthal in which it was found that antibody and lymphocytes jointly produce ion-conducting channels in planar bilayers of "oxidized cholesterol." In order to supplement and extend this approach we have made an exploratory study of 86Rb+ and 51Cr marker release from lecithin/cholesterol/dicetyl phosphate liposomes by antibody and nonadherent mouse spleen cells. Evidence is presented indicating that the antibody and cells cause direct synergistic marker release from liposomes into the fluid medium. This indicates that they have the capacity to damage phospholipid bilayers. Hence, it seems worthwhile to conduct further studies of the liposome model in order to uncover the mechanism of membrane damage and to assess its relevance to cell-mediated cytotoxicity.

In vivo responses to inhaled proteins. II. Induction of interstitial pneumonitis and enhancement of immune complex-mediated alveolitis by inhaled concanavalin A

An animal model of environmental lung disease is described in which phytomitogen, antigen, or both, are administered in aerosol form to previously immunized or immunologically naive rabbits. Inhalation of concanavalin A alone induced an interstitial pneumonitis in nonimmunized rabbits. Inhalation of concanavalin A alone induced an interstitial pneumonitis in nonimmunized rabbits. Inhalation of bovine serum albumin (BSA) alone typically produced only focal eosinophilic granulomas in BSA-immunized animals, and no injury whatever in nonimmune animals. However, simultaneous administration of BSA-concanavalin A aerosol mixtures to BSA-immunized rabbits induced a severe interstitial pneumonitis and granulomatous vasculitis, together with areas of frank parenchymal necrosis. When repeated on a chronic basis over a 4- or 8-week interval, challenge with BSA-concanavalin A aerosols resulted in both acute necrotic lesions as well as areas of frank interstitial fibrosis. Necrotic foci in acutely injured lungs were associated with interstitial deposits of BSA, rabbit anti-BSA antibody, and complement. Electron microscopy revealed numerous neutrophils within the pulmonary interstitial spaces of these animals, often in association with collagen and elastin fibers. The pattern of injury in immune rabbits induced by antigen-concanavalin A aerosols, in its nonnecrotizing form, is consistent with that of an extrinsic allergic alveolitis. However, the severe, necrotizing form of acute injury closely resembles changes seen in Wegener's granulomatosis. Possible mechanisms of injury produced by antigen and phytomitogen inhalation are discussed.