Socioeconomic inequalities in neonatal intensive care admission rates

OBJECTIVE

To examine socioeconomic inequalities in neonatal intensive care (NIC) admissions relating to preterm birth, intrauterine growth restriction (IUGR), multiple births and other conditions.

METHODS

Retrospective review of all NIC admissions from 1996 to 2001 throughout a geographically defined region. Area deprivation indices were grouped into quintiles from least (1) to most (5) deprived. Admissions were classified by predefined hierarchical criteria.

RESULTS

The rate of admissions was 31.4 per 1000 births. There was a J-shaped relation with socioeconomic group (28.1 NIC admissions per 1000 in quintile 1, 34.0 in quintile 5 and below 28 in the other quintiles). The most deprived areas had a rate 19% above the regional average. The relation with socioeconomic group differed significantly according to primary reason for admission. The rates of admissions with significant prematurity (34% of all admissions) and IUGR as primary reason were highest in quintile 5 (18% and 41% above the regional average, respectively). This contrasted with the rate of admission for multiple birth which was highest in quintile 1 (45% above average). These differences provided the main explanation for the J-shaped overall curve.

CONCLUSIONS

Measures to alleviate deprivation and to improve the preterm birth and IUGR rates in deprived groups would have the greatest potential to reduce inequality in need for NIC admission. Efforts to achieve targets for reduction in infant mortality need to take account of the different effects of socioeconomic inequalities for different conditions and groups of infants.

Improvement in neonatal intensive care in Northern Ireland through sharing of audit data

PROBLEM

Ten percent of infants born will require admission to a neonatal facility. Coordinated activity to monitor and improve the quality of care for this high risk, high cost group of infants is considered a high priority. At the time of initiation of this project no system for collection and analysis of neonatal data existed in Northern Ireland.

DESIGN

In 1994 an ongoing prospective centralised data collection system was implemented to facilitate quality improvement and research in neonatal care. We aim to ascertain if there has been a demonstrable improvement in the quality of care provided since the initiation of this system.

SETTING

All nine Northern Ireland neonatal intensive care units returned prospectively collected socioeconomic, obstetric and neonatal episode data.

KEY MEASURES FOR IMPROVEMENT

Achievement of the agreed quality indicators relating to transfer patterns, thermoregulation, antenatal steroid administration, and timing of administration of surfactant during the period 1 April 1999 to 31 March 2000 were compared with data for the period 1 April 1994 to 31 March 1996.

STRATEGIES FOR CHANGE

Monitoring included audit and annual feedback of timely clear and relevant data where results were provided confidentially as standardised reports, together with anonymised comparisons with other similar sized units. Draft recommendations were made at regional level and units were asked to adopt finalized consensus guidelines at the local level and to implement changes to clinical practice.

EFFECTS OF CHANGE

The proportion of transfers taking place in utero increased from 26% to 42% and antenatal steroid administration from 68% to 82%. Normothermia on first admission improved from 66% to 71% for inborn infants. The proportion of infants receiving surfactant where the first dose was given within an hour of birth increased from 13% to 66%.

LESSONS LEARNT

A multi-professional regional care network can facilitate the development of agreed standards and a culture of regular evaluation leading to quality improvement.

Long-term respiratory support in children with giant omphalocele

Omphalocele is one of the most common fetal abdominal wall defects. When this defect is of giant size, significant respiratory compromise may occur and impact on prognosis. We present three infants with giant omphalocele, highlighting the potential need for ongoing ventilatory support after the neonatal period in children born with this condition. The three cases had very different outcomes but all had significant ventilatory insufficiency and required substantial respiratory support at least into the second year of life. The possibility of a requirement for long-term ventilatory support should be discussed with families at antenatal diagnosis. A conservative surgical approach, together with early monitoring for hypoventilation and screening for the development of pulmonary hypertension is indicated for these children to limit morbidity. We suggest early tertiary respiratory input and advocate for a specific case manager to oversee the regional care of these children.

More and earlier surfactant for preterm infants

Surfactant administration to infants born at less than 32 weeks gestation was compared between two time periods (1 April 1994 to 31 March 1996 and 1 April 1999 to 31 March 2001). Overall administration increased significantly from 41% to 54%, and within one hour of birth from 13% to 60%. Regional data collection and feedback helps promote quality improvement and implementation of published evidence and guidelines.

Admission to neonatal intensive care with respiratory morbidity following 'term' elective caesarean section

Delaying the timing of elective caesarean section (ELCS) from 37/38 weeks to 39/40 weeks reduces the risk of respiratory morbidity in otherwise healthy neonates. The aims of this study were to clarify the number and clinical details of term infants delivered by ELCS who were admitted to neonatal intensive care (NIC) from 1st April 2001 to 31st March 2002 in Northern Ireland, to record the level of care required by these infants and to identify infants who were diagnosed with transient tachypnoea of the newborn (TTN) and/or Respiratory Distress Syndrome (RDS). Two hundred and ten (8%) of babies born by ELCS were admitted to NIC. Term infants delivered by ELCS used 343 days of level 1 & 2 care with 230 (68%) of these days being used by infants with RDS/TTN (n=105) the majority of whom were delivered at 37/38 weeks. Definitions of 'term' and clinical indications for ELCS urgently need to be debated to avoid unnecessary morbidity following ELCS in so called 'term' infants.

Making information available for quality improvement and service planning in neonatal care

We describe a prospective two year study aimed at assessing information collected throughout a geographically defined region as a basis for clinical governance, quality improvement and service planning in neonatal intensive and special care. All 13 Northern Ireland units returned a range of socio-demographic, obstetric and neonatal data for all admissions or readmissions within 28 days of life. 8.2% of all live births required neonatal intensive or special care, with a requirement of 374 and 645 days per 1,000 births for intensive and special care respectively. In total there were 4,205 episodes of care provided for 3,946 infants (18,072 days of intensive and 31,141 days of special care). Complications arising during intensive care episodes included the following: septicaemia/bacteraemia (7.6%), necrotising enterocolitis (2.8%), pneumothorax (4.6%), patent ductus arteriosus (6.5%) and seizures (6.9%). Opportunities for quality improvement exist in a number of areas with potential for further reduction in morbidity. Comparisons with published criteria demonstrate the value of this type of information for local, regional and national quality improvement initiatives and service planning.

Protein kinase C-alpha and -epsilon modulate connexin-43 phosphorylation in human heart

We have previously demonstrated that protein kinase C (PKC)- alpha expression is significantly elevated in failing human left ventricle, with immunostaining showing increased PKC- alpha localization at the intercalated disks of cardiomyocytes. In the present study we sought to determine, in the failing heart, if PKC- alpha interacted with connexin-43 (Cx-43) both spatially and functionally, and to compare the association of PKC- alpha/Cx-43 with that of PKC- epsilon, a PKC isozyme that does not significantly increase in failing hearts. The possibility of a PKC- alpha or PKC- epsilon/Cx-43 association in non-failing hearts was also investigated. Co-immunoprecipitation of PKC- alpha or PKC- epsilon and Cx-43 in non-failing and failing left ventricle was achieved using antibodies to PKC- alpha or Cx-43. Confocal microscopy confirmed that PKC- alpha distribution within the cardiomyocyte included co-localization with connexin-43 in both failing and non-failing myocardium. In a similar manner, confocal imaging of PKC- epsilon showed cardiomyocyte distribution in both cytosol and membrane, and colocalization of PKC- epsilon with Cx-43. Recombinant PKC- alpha or - epsilon increased PKC activity significantly above endogenous levels in the co-immunoprecipitated Cx-43 complexes (P<0.05). However, phosphorylation of purified human Cx-43 (isolated from failing human left ventricle) by recombinant PKC- alpha or PKC- epsilon resulted in only PKC- epsilon mediated Cx-43 phosphorylation. Thus, in the human heart PKC- alpha, PKC- epsilon, and Cx-43 appear to form a closely associated complex. Whereas only PKC- epsilon directly phosphorylates Cx-43, both PKC isoforms result in increased phosphorylation within the Cx-43 co-immunoprecipitated complex.

Factors that control sarcoplasmic reticulum calcium release in intact ventricular myocytes

Much has been discovered studying sarcoplasmic reticulum (SR) Ca release channels in SR vesicles and lipid bilayers. We have focused on how SR Ca release is regulated in intact mammalian ventricular myocytes, using fluorescent Ca indicators, voltage clamp, and confocal microscopy. Three major factors appear to contribute to the probability of spontaneous localized SR Ca release events (or Ca "sparks") in resting myocytes: (1) cytosolic [Ca], (2) SR Ca content, and (3) time after previous activity (i.e., recovery from adapted or inactivated state). These same three factors function during excitation-contraction (E-C) coupling and can explain rest potentiation of twitches, increased fractional SR Ca release at higher SR Ca loads, and Ca overload. Since SR Ca release is sensitive to both ICa and SR Ca load, we have controlled (and measured) these parameters. At constant SR Ca load and ICa in intact cells we have found that SR Ca release is increased by Ca-calmodulin-dependent protein kinase (CaMKII) and FK506 (which may interfere with the interaction between the Ca release channel and the FK binding protein) and is reduced by the Ca channel agonist Bay K 8644, CaMKII inhibitors, and during ventricular hypertrophy. Thus the regulation of the SR Ca release channel in the intact cell is an important factor in cellular cardiac function.

Ca flux, contractility, and excitation-contraction coupling in hypertrophic rat ventricular myocytes

Left ventricular hypertrophy (approximately 40%) was induced in rats by banding of the abdominal aorta. After 16 wk, ventricular homogenates were prepared for biochemical measurements and ventricular myocytes were isolated for functional studies. In myocytes, the effects of banding on intracellular Ca handling, contraction, and excitation-contraction (E-C) coupling were determined using indo 1 fluorescence and whole cell voltage clamp. After steady-state field or voltage-clamp stimulation to load the sarcoplasmic reticulum (SR), SR Ca content assessed by caffeine-induced Ca transients was the same in sham and banded groups. Despite this, cell shortening amplitudes were significantly depressed in the banded group, suggesting altered contractile properties. In banded rats, the SR Ca-adenosinetriphosphatase (Ca-ATPase) mRNA level was reduced, as was homogenate thapsigargin-sensitive SR Ca-ATPase, but cytosolic free Ca concentration ([Ca]i) decline attributed to SR Ca-ATPase activity in intact cells was not slowed. Banding also reduced Na/Ca exchange mRNA level but did not affect either Na-dependent sarcolemmal 45Ca transport in homogenate or the rate of [Ca]i decline in intact cells attributed to Na/Ca exchange (during caffeine-induced contractures). Banding also did not change the rate of [Ca]i decline mediated by the combined function of the mitochondrial Ca uptake and sarcolemmal Ca-ATPase in intact cells. Ca current (ICa) density and voltage dependence were the same in sham and banded groups. Ryanodine receptor mRNA, protein content, and ryanodine affinity were also unchanged in the banded group. At 1 mM extracellular Ca concentration ([Ca]o), banding did not affect E-C coupling efficacy in intact cells under voltage clamp (i.e., same contraction for given ICa and SR Ca load). However, when [Ca]o was reduced to 0.5 mM, the efficacy of E-C coupling was greatly depressed in the banded group (even though ICa and SR Ca content were matched). In summary, unloaded myocyte contraction was depressed in these hypertrophic hearts, but Ca transport was little altered, at 1 mM [Ca]o. However, reduction of [Ca]o to 0.5 mM appears to unmask a depressed fractional SR Ca release in response to a given ICa trigger and SR Ca load.

Crisis at the Bureau of Veterinary Drugs

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The use of the pleuro-peritoneal shunt

The pleuro-peritoneal shunt is a device that uses a pump chamber and one-way valves to control the build-up of excess fluid in the pleural space around the lungs of patients with recurrent pleural effusions. It provides an alternative to repeated needle withdrawls or to chest tube placement. This article looks at the shunt in detail and the post-operative care given to the patient.

Acute renal failure in the paediatric intensive care unit

AIMS

To review a group of children with acute renal failure (ARF) requiring renal replacement therapy in a paediatric intensive care unit (PICU).

METHODS

Case records of children admitted to paediatric intensive care unit between January 1992 and July 1995 were reviewed for demography, diagnosis, modality of treatment, duration, complications of therapy and renal outcome. Long term follow up was sought from patients' referring paediatricians.

RESULTS

Twenty children with a mean age of 2 years and 3 months required acute renal replacement therapy. The most common cause was diarrhoea associated haemolytic uraemic syndrome with a mean duration of dialysis of 11.5 (SD 3.1) days (range 5-15. Four children had septicaemic illnesses; three with multiorgan system failure, one of whom died. Peritoneal dialysis was the only modality in 16 patients and four children were treated with continuous venovenous haemofiltration. Eight of the 20 patients were discharged from the paediatric intensive care unit with normal renal function as judged by serum creatinine. Long-term follow up showed normalisation of serum creatinine in a further eight of ten patients.

CONCLUSIONS

The most common cause of acute renal failure was diarrhoea associated haemolytic uraemic syndrome with an excellent outcome (100% patient survival). Children who had acute renal failure due to other illnesses had a higher mortality (27%).

Effects of FK-506 on contraction and Ca2+ transients in rat cardiac myocytes

FK-506 binding protein (FKBP) has been reported to be closely associated with the ryanodine receptor in skeletal and cardiac muscle and to modulate sarcoplasmic reticulum (SR) Ca2+ release channel gating in isolated channels. FK-506 can inhibit the activity of FKBP, thereby reversing its effects on SR Ca2+ release. We investigated the function of FKBP during normal contractions and Ca2+ transients in intact rat ventricular myocytes loaded with fluorescent Ca2+ indicators. FK-506 significantly increased steady state twitch Ca2+ transients and contraction amplitudes even under conditions in which the SR Ca2+ load and Ca2+ current were unaltered, suggesting that FK-506 increases the fraction of SR Ca2+ released during excitation-contraction (E-C) coupling. Action potentials were somewhat prolonged, consistent with the larger Ca2+ transients causing greater inward Na(+)-Ca2+ exchange current. FK-506 did not affect SR Ca2+ uptake but modestly decreased Ca2+ extrusion via Na(+)-Ca2+ exchange in intact cells (although no effect on Na(+)-Ca2+ exchange was seen in sarcolemmal vesicles). In most cells, FK-506 caused an increase in SR Ca2+ content during steady state stimulation, as assessed by caffeine-induced contractures. This was probably due to the inhibition of Ca2+ efflux via Na(+)-Ca2+ exchange. FK-506 also accelerated the rest decay of SR Ca2+ content and increased the frequency of resting Ca2+ sparks about fourfold. The increase in frequency of these basic Ca2+ release events was not associated with changes in the amplitude or duration of the Ca2+ sparks. We conclude that FK-506 increases the fraction of SR Ca2+ released during normal twitches and enhances the rate of SR Ca2+ release during rest. FK-506 also inhibits Na(+)-Ca2+ exchange, although this effect may be indirect. These effects are consistent with an important SR-stabilizing effect of FKBP in intact rat ventricular myocytes.

Horizontal violence in nursing: the continuing silence

Horizontal violence continues to affect the lives of many nurses today. This paper will present the findings of research which utilised a feminist methodology to document the stories of nurses illustrating their experiences of horizontal violence in their workplaces, and their perceptions of the reasons for the continued oppression of nurses, despite almost fifteen years of academic writing on the subject.

BAY K 8644 depresses excitation-contraction coupling in cardiac muscle

We determined the effect of the dihydropyridine L-type Ca channel agonist BAY K 8644 (BAY) on excitation-contraction (E-C) coupling in isolated ferret ventricular myocytes using whole cell voltage clamp. The sarcoplasmic reticulum (SR) Ca load during the test pulses, assessed by caffeine-induced contractures, was similar in the presence and absence of BAY, with extracellular Ca concentration lowered from 3 to 1 mM in BAY. The relationship between L-type Ca current (ICa) and contraction was assessed, with current and contractions measured during depolarizations from -40 to between -30 and +50 mV after a conditioning train (to ensure constant SR Ca load). BAY shifted the current-contraction relationship downward, such that, for a given ICa and SR Ca load, the contraction elicited was much smaller in the presence of BAY. BAY also induced a characteristic negative shift in the the current-voltage relationship. We conclude that BAY decreases the efficacy of a given Ca current to induce SR Ca release during E-C coupling in ferret cardiac tissue (in contrast to the BAY-induced increase of resting SR Ca release). This may reflect an alteration in the state of the SR Ca release channel due to BAY binding to dihydropyridine receptors.

Possible functional linkage between the cardiac dihydropyridine and ryanodine receptor: acceleration of rest decay by Bay K 8644

The effect of the dihydropyridine L-Type Ca chanel agonist Bay K 8644 on post-rest contractions in ferret ventricular muscle and isolated myocytes was investigated. Bay K 8644 was shown to abolish rest potentiation and greatly accelerate rest decay. The post-rest contraction suppressed by Bay K 8644 was accompanied by action potentials of large amplitude and longer duration, but voltage-clamp measurements showed that this suppression was not due to a supra-optimal ICa trigger. Caffeine-induced contractures and rapid cooling contractures demonstrated an accelerated rest-dependent decline in sarcoplasmic reticulum (SR) Ca content in the presence of Bay K 8644, which was present even with Ca-free superfusion during rest. Thus, the Bay K 8644-induced decline of SR Ca during rest was independent of extracellular Ca or ICa. To explore whether the binding of Bay K 8644 to the dihydropyridine receptor could alter the SR Ca release channel/ryanodine receptor in a more direct way, ryanodine binding was measured in the absence and presence of Bay K 8644. Ryanodine binding to isolated ferret ventricular myocytes was increased by Bay K 8644 under conditions where sarcolemmal-SR junctions might be expected to be intact, but not after physical disruption. These results are consistent with a working hypothesis where Bay K 8644 may bind to the dihydropyridine receptor and this may lead to physical changes in the linkage between the dihydropridine receptor and a subset of ryanodine receptors, thereby increasing the opening of the SR Ca release channel during rest (and accelerating resting Ca loss).

A review of children's dying in a paediatric intensive care unit

AIM

To identify methods of treatment withdrawal, staff support and follow up of families with children dying in a paediatric intensive care unit (PICU).

METHOD

A retrospective review of the 25 children who died in the PICU over 1992 was made.

RESULTS

There were two groups of patients. Group A (16 children) had cessation of active treatment. The decision to cease treatment took a median time of 16 hours and was always made in consultation with other specialists and family. Cessation of artificial ventilation was the most common mechanism of treatment withdrawal. Supplemental morphine was administered to 8 children. Group B (9 children) had continuation of active resuscitation until death. The child's family was present at the time of death in both groups. Te Whanau Atawhai (a Maori liaison group) played an active support role to 18 families. Follow up of bereaved families and staff support was poor.

CONCLUSIONS

Family members are willing to take an active part in the decision making process regarding management of the dying child. This process is multidisciplinary, time consuming and difficult. Valuable assistance for all ethnic groups was gained through the services of Te Whanau Atawhai. Consideration should be given to allowing parents to stay during acute resuscitation of a critically ill child. There were deficiencies of both parental and staff followups. As a consequence, we have introduced a grief education and support service through the, child and family psychiatric service for families and staff.

Differential release of proopiomelanocortin-derived peptides from the human pituitary: evidence from a panel of two-site immunoradiometric assays

In humans, proopiomelanocortin (POMC) and the peptides derived from it have been individually identified in plasma under differing conditions. However, direct quantitative comparison has proved difficult because of the limitations of RIAs. Using a panel of monoclonal antibodies recognizing different regions of POMC, we have developed specific two-site immunoradiometric assays (IRMAs) for the ACTH precursors (POMC and pro-ACTH), ACTH, beta-lipotropin (beta LPH), beta-endorphin (beta EP), and the N-terminal POMC fragment (N-POC). We have quantified these peptides directly in plasma from normal subjects under basal conditions and in response to different regulatory factors. Basal levels of ACTH precursors, 5-40 pmol/L, were greater than or equal to ACTH, less than 0.9-11.3 pmol/L; N-POC, 5.6-16.8 pmol/L; beta LPH, 2.5-6.7 pmol/L; and beta EP less than or equal to 1.7 pmol/L. ACTH, N-POC, beta LPH, and beta EP levels increased in parallel in response to metyrapone (n = 8) and decreased in response to dexamethasone (n = 8), whereas ACTH precursor concentrations did not respond. After human CRH administration, peripheral concentrations of ACTH, N-POC, and beta LPH showed similar increments (median increment, 163%, 145%, and 172%, respectively; n = 6). POMC peptide responses to human CRH were also assessed in inferior petrosal sinuses draining the pituitary in 20 patients with pituitary-dependent Cushing's disease. In these patients, the increment in ACTH after CRH exceeded that in ACTH precursors by 4-fold (median, 459% and 96%). An increase in the ratios of ACTH/N-POC and ACTH/beta LPH was also apparent after CRH stimulation. The increment in beta EP after CRH always exceeded the increments in POMC and beta LPH. In summary, these data suggest that significant concentrations of ACTH precursors are present in the circulation of normal subjects, that ACTH precursors are not regulated in the same way as the processed POMC peptides, and that ACTH and beta EP are preferentially released from the pituitary in response to CRH.

Introduction of continuous regional techniques for postoperative paediatrics patients: one years' experience from two hospitals

AIM

To review the use, safety and efficacy of continuous regional techniques in children and neonates.

METHODS

The records of all children who received postoperative continuous regional analgesic techniques during the year 1992 at the Starship Children's Hospital and Waikato Base Hospital were reviewed. In both post operative care units orders, procedures and protocols were standardised.

RESULTS

A total of 80 children received these techniques. Patients were cared for in high dependency nursing areas. The two techniques used were epidural and interpleural analgesia. Epidural: The majority (68) had epidural catheters and of these 13 infants were in their first month of life. Major problems occurred in six (9%) of children receiving epidurals--two blocks failed completely, two suffered subarachnoid puncture, one had respiratory depression and one developed a foot-drop. The blockade failure and subarachnoid punctures occurred early in the establishment of paediatric epidural analgesic services. Minor problems included the necessity for morphine supplementation in three (4%) children, leaks about the catheter in seven (10%), nausea and vomiting in six (9%), two (3%) developed pruritus and one block was ceased because of concerns expressed about masking symptoms of compartmental compression. Interpleural: twelve patients were treated with this technique. One neonate suffered a convulsion.

CONCLUSION

Major continuous regional techniques in paediatric patients are effective, but because of potential complications, there is a requirement that these blocks be performed, monitored and cared for by staff experienced and trained with these procedures.

The role of Na(+)-Ca2+ exchange in paired pulse potentiation of ferret ventricular muscle

1. Stimulation of cardiac muscle with pairs of stimuli ('paired pulse stimulation') results in a large inotropic effect and experiments have been carried out on ferret ventricular muscle to investigate the underlying mechanism. 2. Aequorin was used to measure sarcoplasmic Ca2+ in papillary muscles. During paired pulse stimulation the first aequorin light transient (i.e. Ca2+ transient) and contraction of the pair increased in amplitude, whereas the second aequorin light transient and contraction were small. When the interval between the pair was decreased, the second aequorin light transient and contraction of the pair were smaller, but the increase in the first aequorin light transient and contraction was greater. 3. The relationship between contraction and the aequorin light transient was the same during paired pulse stimulation and on raising the bathing Ca2+ concentration. It is concluded that there was no change in the myofilament sensitivity to Ca2+ during paired pulse stimulation. 4. The increase in the aequorin light transient and contraction during paired pulse stimulation was prevented by ryanodine, an inhibitor of the sarcoplasmic reticulum (SR). 5. During paired pulse stimulation of ventricular myocytes there was little change in the first action potential of the pair, but the second action potential was shorter than control when the interval between the pair was short. During paired pulse stimulation of ventricular myocytes under voltage clamp control there was little change in the first Ca2+ current (iCa) of the pair, but the second iCa was smaller than control when the interval between the pair was short. Because paired pulse potentiation was greatest when the interval between the pair was short, it is concluded that paired pulse potentiation was not the result of a prolongation of the action potential or increase in iCa. 6. During paired pulse stimulation of ventricular myocytes under voltage clamp control the increase in contraction was greater, the more positive the membrane potential during the second pulse of the pair. This voltage dependence is consistent with a role for the Na(+)-Ca2+ exchanger in paired pulse potentiation. 7. During paired pulse stimulation of ventricular myocytes under voltage clamp control, changes in putative Na(+)-Ca2+ exchange current were observed consistent with a decrease of Ca2+ efflux (or increase of Ca2+ influx) via the exchanger during the second pulse of the pair. 8. A computer model of excitation-contraction coupling (Harrison, McCall & Boyett, 1992) has been used to simulate paired pulse stimulation and the results described above.(ABSTRACT TRUNCATED AT 400 WORDS)

The relationship between contraction and intracellular sodium in rat and guinea-pig ventricular myocytes

1. The contraction, measured optically, and the intracellular Na+ activity (aNai), measured with the Na(+)-sensitive fluorescent dye SBFI, have been recorded simultaneously in rat and guinea-pig ventricular myocytes. 2. In rat and guinea-pig ventricular myocytes at rest, aNai was 7.8 +/- 0.3 mM (n = 4) and 5.1 +/- 0.3 mM (n = 16), respectively. 3. When both rat and guinea-pig ventricular myocytes were stimulated at 1 Hz after a rest there was usually a gradual increase in twitch shortening (referred to as a 'staircase') over several minutes accompanied by an increase in aNai over a similar time course. Twitch shortening increased by 21 +/- 3% (n = 6) and 20 +/- 4% (n = 16) (of steady-state twitch shortening during 1 Hz stimulation) per millimolar rise in aNai in rat and guinea-pig ventricular myocytes, respectively. 4. When rat and guinea-pig ventricular myocytes were exposed to strophanthidin to block the Na(+)-K+ pump, there were increases in twitch shortening and aNai over similar time courses. Twitch shortening increased by 24 +/- 4% (n = 5) and 20 +/- 3% (n = 10) (of control twitch shortening) per millimolar rise in aNai in rat and guinea-pig ventricular myocytes respectively. 5. The inotropic effect of cardiac glycosides, such as strophanthidin, is widely regarded to be principally the result of the rise in aNai. The similarity of the relation between twitch shortening and aNai during the staircase and on application of strophanthidin suggests that the progressive increase in the strength of contraction during the staircase was also linked to the rise in aNai. 6. In guinea-pig, but not rat, ventricular myocytes there was hysteresis in the relation between twitch shortening and aNai on application and wash-off of strophanthidin. This indicates that strophanthidin has another inotropic action in guinea-pig ventricular myocytes. 7. A computer model of excitation-contraction coupling has been developed to simulate the staircase and the action of cardiac glycoside and to account for the relation between contraction and intracellular Na+.

Contraction and intracellular Ca2+, Na+, and H+ during acidosis in rat ventricular myocytes

We have investigated the effect of a CO2-induced (respiratory) acidosis on contraction and on intracellular Ca2+, Na+, and pH (measured using the fluorescent dyes fura-2, sodium-binding benzofuran isophthalate, and 2',7'-bis(carboxyethyl)-5,6-carboxyfluorescein, respectively) in ventricular myocytes isolated from rat hearts. Initial exposure to acidosis led to a rapid decrease in intracellular pH that was accompanied by an abrupt decline in contractility. There were no consistent changes of intracellular Na+ or Ca2+ during this period. The rapid decline of contractility was followed by a slower partial recovery, which was accompanied by increases in intracellular Na+, systolic and diastolic Ca2+, and an increase in the Ca2+ content of the sarcoplasmic reticulum (estimated using caffeine). Intracellular pH did not change during this slow recovery. The slow rise of intracellular Na+ and the recovery of the twitch were blocked by the Na(+)-H+ exchange inhibitor amiloride. The sarcoplasmic reticulum inhibitor ryanodine blocked the recovery of the twitch but had no effect on the rise of intracellular Na+ induced during acidosis. It is concluded that a major cause of the initial decline of the twitch during acidosis is a decrease in the response of the contractile proteins to Ca2+ due to the decrease of intracellular pH. The subsequent slow recovery of the twitch is due to the decrease of intracellular pH activating the Na(+)-H+ exchange mechanism. This elevates intracellular Na+ and presumably, via the Na(+)-Ca2+ exchange mechanism, intracellular Ca2+. This in turn may lead to increased Ca2+ loading of, and hence release from, the sarcoplasmic reticulum, and it is this that underlies the partial recovery of contraction during acidosis in this preparation.

The effect of acidosis on the relationship between Ca2+ and force in isolated ferret cardiac muscle

1. The relationship between force and intracellular [Ca2+] (monitored using the protein aequorin) has been investigated in papillary muscles isolated from ferret hearts, under control conditions (superfusate pH (pHo) 7.3) and during acidosis (pHo 6.8). 2. At pHo 7.3, increasing bathing [Ca2+] from 0.5 mmol l-1 to 8 mmol l-1 led to an increase in the size of the intracellular calcium transient. At the lower [Ca2+] this was accompanied by an increase in developed force; however, at the higher bathing [Ca2+] developed force reached a plateau. 3. Acidosis (produced by increasing the [CO2] of the gas with which the muscle superfusate was equilibrated) decreased maximum force and shifted the curve relating peak developed force to peak intracellular [Ca2+] to the right. 4. The mechanisms underlying the apparent decrease in the sensitivity of the contractile proteins to Ca2+ were investigated by applying rapid length changes to papillary muscles at control pHo, during acidosis, and after bathing [Ca2+] had been increased to match force during acidosis to that in control. 5. Acidosis decreased the change in force produced in response to a given length change (i.e. decreased muscle stiffness) but when bathing [Ca2+] was increased during acidosis, muscle stiffness returned to control. 6. Acidosis had no effect on muscle stiffness after the induction of rigor in the muscle (produced by metabolic inhibition). 7. It is suggested that in intact cardiac muscle the major effect of a mild acidosis is to decrease the sensitivity of the contractile proteins to Ca2+, hence decreasing the number of bound cross-bridges.

Mechanical alternans during acidosis in ferret heart muscle

Acidosis leads to mechanical alternans (i.e., alternation of large and small contractions) in ferret papillary muscles. This alternation in the size of the contraction is paralleled by alternation in the size of the intracellular Ca2+ transient (monitored using the photoprotein aequorin). In isolated myocytes, the large contraction is accompanied by a prolonged action potential. Mechanical alternans also can be induced by acidosis in isolated myocytes during a train of voltage-clamp pulses. Thus, it appears unlikely that the mechanical alternans is secondary to changes in action potential duration; it is more likely that the observed changes in action potential duration are secondary to changes in the size of the Ca2+ transient. The observation that a Ca2(+)-activated inward current also shows alternation during mechanical alternans provides a possible mechanism for the link between Ca2+ and action potential duration. The alternation in the size of the Ca2+ transient may be secondary to the slowed mechanical restitution observed in papillary muscles during acidosis. This also could explain the observation that decreasing stimulation rate can abolish the alternans.

The effect of acidosis on the interval-force relation and mechanical restitution in ferret papillary muscle

1. The effect of a respiratory acidosis on the interval-force relation and on mechanical restitution was investigated in ferret papillary muscles. 2. Acidosis (pH 6.85) decreased developed force over a range of stimulation frequencies (1.0.06 Hz); the percentage decrease was greatest at the lowest stimulation frequencies. Qualitatively similar effects of acidosis on developed force were observed in the presence of the sarcoplasmic reticulum (SR) inhibitor ryanodine. 3. Mechanical restitution curves were constructed by interpolating extra-systoles at different test intervals following a train of steady-state beats. Mechanical restitution in ferret papillary muscle was triphasic: an initial, rapid, exponential increase in force with test intervals to 2 s, a further increase with test intervals between 60 and 90 s and then a slow decline, with a plateau at about 30 min (0.33 Hz, 30 degrees C). 4. Acidosis slowed the initial phase of mechanical restitution. The degree of slowing depended on the steady-state stimulation frequency, being greatest at low frequencies. 5. Inhibition of the SR abolished the initial phase of mechanical restitution, suggesting that this phase depends on Ca2+ release from the SR. 6. The strength of the first contraction after the extra-systole varied inversely with the size of the extra-systole under all conditions studied. 7. It is concluded that acidosis may inhibit the SR by altering the time required for Ca2+ recycling between contractions. This effect may alter Ca2+ release from the SR during acidosis, and may underlie the mechanical alternans (the alternation of small and large contractions) that can occur during acidosis.

Erythroid burst-promoting activity produced by interleukin-1-stimulated endothelial cells is granulocyte-macrophage colony-stimulating factor

Interleukin-1 (IL-1) induces cultured human umbilical vein endothelial cells to elaborate heterogeneous hematopoietic growth factors, including granulocyte-macrophage and granulocyte colony-stimulating factors (GM-CSF and G-CSF, respectively). Because erythroid burst-promoting activity (BPA) is also elaborated by endothelial cells exposed to IL-1, we sought to determine whether the BPA released by IL-1-induced endothelial cells simply reflects the known erythropoietic activity of GM-CSF or whether other uncharacterized factors might be involved. Media conditioned by multiply passaged endothelial cells cultured for three days with recombinant IL-1 alpha (ECMIL-1) stimulated erythroid burst and GM colony formation in cultures of human nonadherent T-lymphocyte-depleted marrow mononuclear cells. Pretreatment with an anti-GM-CSF antiserum neutralized all the BPA and 56% of the GM colony-stimulating activity (GM-CSA) in ECMIL-1. The antiserum used in these studies did not inhibit IL-3 or G-CSF activity and did not inhibit ECMIL-1-induced murine GM colony growth (a measure of human G-CSF). To examine whether GM-CSF induces BPA release by accessory cells, media conditioned by marrow cells cultured for three days with GM-CSF were tested in the colony growth assays. Pretreatment with anti-GM-CSF antiserum completely neutralized the BPA and GM-CSA of the marrow cell-conditioned medium. We conclude that GM-CSF is the BPA elaborated by IL-1-induced endothelial cells. The in vitro erythropoietic activity of GM-CSF is not dependent on induced BPA release by accessory cells and therefore likely results from a direct effect of GM-CSF on progenitor cells.

Interleukin 1-dependent paracrine granulopoiesis in chronic granulocytic leukemia of the juvenile type

Marrow and peripheral blood cells from nine children with juvenile chronic granulocytic leukemia (JCGL) demonstrated intense (94 +/- 16% maximum) spontaneous granulocyte/macrophage colony growth but cells from five children with the adult variety of CGL did not. This unusual pattern of colony growth depended upon a stimulatory protein(s) produced by mononuclear phagocytes. No GM-CSA activity was found in any chromatofocused fraction of JCGL monocyte-conditioned media but an activity that induced GM-CSA in umbilical vein endothelial cells was detected at pI 6.9-7.2. Moreover, the CSA-inducing monokine was neutralized by an anti-IL-1 antibody in vitro and, in the one case so tested, the same antibody also inhibited "spontaneous" colony growth. Therefore granulocyte/macrophage colony growth in JCGL is characteristically abnormal and distinguishes JCGL from the adult form of the disease. This abnormality depends upon the production, by mononuclear phagocytes, of IL-1 which, in turn, stimulates the release of high levels of colony stimulating activity by other cells. The high proliferative activity of CFU-GM we found in JCGL patients, and the high levels of GM-CSA found in their serum are compatible with the view that the in vitro abnormality reflects a similar abnormality in vivo.

Abnormal GM-CSA generation by lymphocytes in patients with cyclic hematopoiesis

Human cyclic hematopoiesis (CH) is a disease characterized by regular 21-day cyclic fluctuations of blood cell counts due to fluctuations in bone marrow cell production. The regular periodicity of the fluctuations suggests a defect in a regulatory feedback control loop. We examined the production of monocyte-derived recruiting activity (MRA) by monocytes and the response to MRA of lymphocytes from three patients with CH. MRA production was normal or increased in patients' monocytes, but granulocyte-macrophage colony-stimulating activity (GM-CSA) production in response to MRA was decreased in lymphocytes from patients with CH (p = 0.005). These data suggest that the regulatory defect in CH may involve defective lymphocyte generation of GM-CSA, resulting in deficient production of mature neutrophils.

Vascular endothelial cells and granulopoiesis: interleukin-1 stimulates release of G-CSF and GM-CSF

Cultured mononuclear phagocytes produce soluble factors that stimulate endothelial cells to release GM-colony-stimulating activity (GM-CSA). One such factor was recently identified as interleukin 1 (IL 1). Studies were designed to determine which types of granulopoietic factors are released by IL 1-stimulated endothelial cells. Supernatants from endothelial cells cultured for 3 days in medium containing IL 1 alpha and beta were tested in both murine and human CFU-GM colony growth assays. The effect of conditioned media on differentiation of WEHI-3B myelomonocytic leukemic cells was also examined. Control media containing IL 1 alone or unstimulated endothelial cell-conditioned media contained no detectable CSA in any bioassay. Medium conditioned by IL 1-stimulated endothelial cells stimulated the clonal growth of both human and murine CFU-GM and induced macrophage differentiation of WEHI-3B cells. Treatment of these conditioned media with a highly specific neutralizing monoclonal G-CSF antibody completely inhibited their activity in the murine CFU-GM assay, but only partially inhibited GM colony growth by human marrow. Treatment of the active conditioned media with a neutralizing rabbit anti-human GM-CSF antibody partially reduced the activity of the media in the human GM-colony growth assay. G-CSF radioimmunoassay of endothelial cell culture supernatants and Northern blot analysis of endothelial cell cytoplasmic RNA for GM-CSF gene transcripts confirmed that IL 1 induced expression of both G-CSF and GM-CSF genes. Because treatment of media with both antibodies abrogated all activity in the human GM colony growth assay, we conclude that IL 1-stimulated endothelial cells release both G and GM-CSF and that these are the only granulopoietic factors detectable in clonogenic assays released by these cells in vitro.

Interleukin 1 stimulates endothelial cells to release multilineage human colony-stimulating activity

Cultured human umbilical vein endothelial cells, when exposed to soluble products of peripheral blood monocytes, elaborate granulocyte-macrophage colony-stimulating activity (GM-CSA) and erythroid burst-promoting activity (BPA). We have performed studies to determine if the monokine IL 1 can stimulate endothelial cells to release hematopoietic growth factors and whether such factors can also support human megakaryocyte (Meg) and mixed-cell colony growth. Various concentrations of recombinant human IL 1 beta (rIL 1) and media conditioned by monocytes (MCM), endothelial cells (ECM), and endothelial cells cultured for 3 days in 50% MCM (ECMM) or rIL 1 (ECMrIL 1) were added to marrow mononuclear cells cultured in methylcellulose. ECMM and ECMrIL 1 stimulated, in a dose-dependent fashion, the growth of Meg, mixed-cell, and GM colonies and erythroid bursts. In contrast, ECM, MCM, and rIL 1 displayed little or no activity in the colony-forming assays. Preincubation with specific antisera to native human IL 1 or rIL 1 reduced by 75 to 100% the activity of MCM in stimulating endothelial cell release of BPA, GM-CSA, Meg-CSA, and mixed-cell CSA. Meg-CSA, although readily detectable at ECMM and ECMrIL 1 concentrations in culture of 1 to 5%, was partially masked by lineage-specific inhibitors of Meg colony growth. When ECMM was analyzed by gel filtration chromatography, the megakaryocytopoietic inhibitory activity eluted in the high Mr fractions (greater than 75 kD). Meg-CSA co-eluted with GM-CSA and BPA in a single peak of 30 kD. We conclude that endothelial cells, in response to IL 1, produce one or more growth factors that probably act on multiple classes of progenitor cells.

Interleukin 1 stimulates endothelial cells to release multilineage human colony-stimulating activity

Cultured human umbilical vein endothelial cells, when exposed to soluble products of peripheral blood monocytes, elaborate granulocyte-macrophage colony-stimulating activity (GM-CSA) and erythroid burst-promoting activity (BPA). We have performed studies to determine if the monokine IL 1 can stimulate endothelial cells to release hematopoietic growth factors and whether such factors can also support human megakaryocyte (Meg) and mixed-cell colony growth. Various concentrations of recombinant human IL 1 beta (rIL 1) and media conditioned by monocytes (MCM), endothelial cells (ECM), and endothelial cells cultured for 3 days in 50% MCM (ECMM) or rIL 1 (ECMrIL 1) were added to marrow mononuclear cells cultured in methylcellulose. ECMM and ECMrIL 1 stimulated, in a dose-dependent fashion, the growth of Meg, mixed-cell, and GM colonies and erythroid bursts. In contrast, ECM, MCM, and rIL 1 displayed little or no activity in the colony-forming assays. Preincubation with specific antisera to native human IL 1 or rIL 1 reduced by 75 to 100% the activity of MCM in stimulating endothelial cell release of BPA, GM-CSA, Meg-CSA, and mixed-cell CSA. Meg-CSA, although readily detectable at ECMM and ECMrIL 1 concentrations in culture of 1 to 5%, was partially masked by lineage-specific inhibitors of Meg colony growth. When ECMM was analyzed by gel filtration chromatography, the megakaryocytopoietic inhibitory activity eluted in the high Mr fractions (greater than 75 kD). Meg-CSA co-eluted with GM-CSA and BPA in a single peak of 30 kD. We conclude that endothelial cells, in response to IL 1, produce one or more growth factors that probably act on multiple classes of progenitor cells.

Interleukin 1 stimulates granulocyte macrophage colony-stimulating activity release by vascular endothelial cells

Studies designed to characterize monocyte-derived recruiting activity (MRA) a monokine that stimulates endothelial cells to produce granulocyte macrophage-colony-stimulating activity (CSA) by endothelial cells, show that it is a thermolabile protein of from 12,000 to 24,000 D which, on chromatofocusing, shows three separate peaks of eluted activity from pH 7.5 to 5.0. Because these and many other properties of MRA are identical to those of interleukin 1 (IL-1), we tested the hypothesis that MRA and IL-1 are identical. We cultured vascular endothelial cells with various concentrations of purified native and recombinant IL-1 (pI 7 form), then tested the endothelial cell supernatants for GM-CSA. Purified native IL-1 and recombinant IL-1 stimulated endothelial cells to release CSA. The MRA of native IL-1, recombinant IL-1, and unfractionated monocyte conditioned medium was neutralized by a highly specific rabbit anti-human IL-1 antiserum. Chromatofocusing fractions that contained MRA contained immunoreactive IL-1 on immunoblotting and the bioactivity was neutralized completely by treatment with the antiserum. We conclude that IL-1 induces the release of CSA by vascular endothelial cells, that IL-1 is constitutively produced by monocytes in vitro, and that MRA and IL-1 are biologically, biophysically and, immunologically identical.

Human placental conditioned medium contains monocyte-derived recruiting activity (MRA)

Monocyte-derived recruiting activity (MRA) stimulates the release of granulopoietic colony-stimulating factors (CSF) by endothelial cells. We carried out studies designed to test the hypotheses that human placental conditioned medium (HPCM), a widely utilized source of CSA for in vitro studies, contains both MRA and CSA and that these molecules could be separated on the basis of their isoelectric points. In five separate studies, concentrated samples of HPCM were chromatofocused and fractions tested in bioassays for MRA and CSA. We found that HPCM contains both MRA and CSA, that the majority of the MRA eluted at a pH of from 7.6 to 8.2 and was 2000-fold purified. CSA eluted at pH 5.6 or below. No CSA was detectable in the major MRA peak. We conclude that HPCM contains heterogeneous granulopoietic activities, that the isoelectric points of MRA and CSA are substantially different and that chromatofocusing provides a rapid single-step method for separating these two distinct granulopoietic factors from complex conditioned media.

Monocyte-derived recruiting activity: kinetics of production and effects of endotoxin

Cultured monocytes release a factor, monocyte-derived recruiting activity (MRA), which stimulates fibroblasts, endothelial cells, and T lymphocytes to produce colony-stimulating activity (CSA). We studied the kinetics of MRA production using a technique in which MRA levels were measured in a two stage bioassay. We used umbilical vein endothelial cells as the MRA-responsive (CSA-producing) cells, and normal colony-forming unit granulocyte-macrophage (CFU-GM)-enriched bone marrow cells (T lymphocyte- and monocyte-depleted, low density bone marrow cells) as the CSA-responsive cells. MRA stimulated a 30-fold increase in CSA production by endothelial cells. MRA production was detected in supernatants from as few as 10(3) monocytes per milliliter, required the presence of fetal calf serum, and was inhibited by cycloheximide (10 to 100 micrograms/mL) and puromycin (10 to 50 micrograms/mL). Production was detectable after 24 hours of monocyte incubation, was maintained for three days, and fell to undetectable levels by seven days. With the addition of bacterial endotoxin (lipopolysaccharide [LPS]) (50 micrograms per 10(6) cells), MRA was detectable after only three hours of incubation, and levels peaked at 24 hours. Further, maximum MRA levels in the supernatants of LPS-stimulated monocytes were up to ten times greater than peak levels in the supernatants of unstimulated monocytes. Endotoxin augmented monocyte production of MRA to a greater extent than it did CSA production, indicating that the stimulation of CSA production by endotoxin may be at least partly indirect. The responsiveness of MRA production to endotoxin in vitro is consistent with the notion that MRA may be a biologically relevant regulator of CSA production by cells of the hematopoietic microenvironment.

A monokine stimulates production of human erythroid burst-promoting activity by endothelial cells in vitro

Conditioned media were prepared from human peripheral blood monocytes and human umbilical vein endothelial cells. These media were assayed for erythroid burst-promoting activity (BPA) using human peripheral blood monocyte-depleted mononuclear cells as targets and assessing the stimulatory effect of the conditioned media on growth of early erythroid progenitor cells. Both monocytes and endothelial cells produced modest amounts of detectable BPA. Addition of varying concentrations of media conditioned by monocytes to plateau concentrations (5-10%) of media conditioned by endothelial cells had no additive effect. Endothelial cells incubated in the presence of 50% monocyte-conditioned medium produced 2.5- to 6.6-fold more BPA than did endothelial cells incubated only in control tissue culture medium. In contrast, endothelial cell conditioned medium did not stimulate increased BPA production by monocytes. Neither neutrophil- nor marrow fibroblastoid cell-conditioned medium stimulated BPA production by endothelial cells. Therefore, both monocytes and endothelial cells produce BPA. Moreover, monocytes produce a monokine that, in turn, stimulates the production of BPA by endothelial cells. Inasmuch as a monokine also has been shown to stimulate production of granulocyte-macrophage colony-stimulating activity, we propose that monocytes play a critical role in regulating the production of humoral regulators of the very early stages of hemopoietic cell differentiation.

Anti-inflammatory drugs, prostanoid and proteoglycan production by cultured bovine articular chondrocytes

The effect of various anti-inflammatory drugs on the production of prostaglandins E2 and F2 alpha, 6 keto PGF1 alpha and thromboxane B2 by bovine articular chondrocytes was measured by radioimmunoassay. While indomethacin and meclofenamic acid caused a dose-dependent inhibition of all prostanoids measured, the effects of hydrocortisone and colchicine varied with respect to different prostanoids. Hydrocortisone (10(-7)M - 10(-13)M) both in the presence and absence of added arachidonic acid, resulted in an inhibition of prostaglandins E2 and F2 alpha, and to a lesser extent, 6 keto PGF 1 alpha, but TxB2 production was only slightly inhibited by the drug in the absence of arachidonic acid and markedly increased in its presence. Colchicine (10(-7)M-10(-3)M) had the opposite effect, causing an inhibition of TxB2 and stimulating PGE2 and 6 keto PGF1 alpha production. These findings suggest that certain anti-inflammatory drugs may, in addition to their action on phospholipase A2 and cyclo-oxygenases, exert potent effects at the level of the different synthetases. In order to see whether these alterations in relative prostanoid levels affected proteoglycan metabolism, the effect of anti-inflammatory drugs on proteoglycan synthesis by cultured chondrocytes was tested using 35SO4 labeling methodology. The results showed that at the concentrations tested (10(-5)M to 10(-7)M), indomethacin, dexamethasone, hydrocortisone and colchicine inhibited 35SO4 incorporation into newly synthesized proteoglycan molecules both in the presence (10(-6)M) and absence of exogenous arachidonic acid. In the same concentration range chloroquine had no effect. These results do not support the hypothesis of direct prostanoid involvement in the modulation of proteoglycan synthesis in articular cartilage.

Hypoxia-induced contractions of porcine pulmonary artery strips depend on intact endothelium

Experiments were carried out to test the hypothesis that intact endothelium is required for hypoxia-induced contractions of pulmonary vascular muscle in vitro. To study this possibility, we cut pairs of transverse strips from main pulmonary arteries of pigs, removed the endothelium from one strip, and mounted the strips on force transducers in separate tissue baths. After an adaptation period of 4-6 h at an oxygen tension of 40 torr, strips with intact endothelium contracted spontaneously when the oxygen tension was decreased from 140 torr to near zero torr (6.5 +/- 1.1 gm-wt/cm2, mean +/- SEM) whereas strips without endothelium contracted significantly less (1.0 +/- 0.3 gm-wt/cm2, p less than 0.001, n = 14 pairs). However, strips with and without endothelium contracted equally in response to incremental concentrations of norepinephrine. Each of several drugs (atropine, propranolol, phentolamine, or indomethacin, each 10(-5) M) had no effect on hypoxia-induced contractions when added to the bath prior to hypoxia. Similarly, a decrease in bath pH from 7.4 to 7.2 had no effect. Because we suspected that the endothelium might be releasing a mediator causing increased tone in response to hypoxia, we cleansed the bath during hypoxia, but this maneuver did not change hypoxia-induced contractions. Placing strips with intact endothelium close to strips without endothelium and measuring tension in the bath during hypoxia did not induce contractions in the strip without endothelium. We conclude that an intact endothelium is necessary for hypoxia-induced contractions in vitro in main pulmonary arteries from pigs. Although main pulmonary arteries are not primarily responsible for hypoxic vasoconstriction in vivo, our findings suggest a possible role for endothelium in the pulmonary vascular response to hypoxia.

A monokine regulates colony-stimulating activity production by vascular endothelial cells

Human umbilical vein endothelial cells were cultured in supernatants of peripheral blood monocytes that had been cultured for 3 days with and without lactoferrin. Colony-stimulating activity (CSA) was measured in supernatants of the endothelial cell cultures and appropriate control cultures using normal, T-lymphocyte-depleted, phagocyte-depleted, low-density bone marrow cells in colony growth (CFU-GM) assays. Monocyte-conditioned medium contained a nondialyzable, heat labile factor that enhanced 4-15--fold the production of CSA by endothelial cells. The addition of lactoferrin to monocyte cultures reduced the activity of this monokine by 69%. Lactoferrin did not inhibit CSA production by monokine-stimulated endothelial cells. Therefore, vascular endothelial cells are potent sources of CSA, the production of CSA by these cells is regulated by a stimulatory monokine, and the production and/or release of the monokine is inhibited by lactoferrin, a neutrophil-derived putative feedback inhibitor of granulopoiesis. Inasmuch as a similar monokine is known to stimulate CSA production by fibroblasts and T lymphocytes, we suggest that mononuclear phagocytes play a pivotal role in the regulation of granulopoiesis by recruiting a variety of cell types to produce CSA.

Regulation of colony-stimulating activity production. Interactions of fibroblasts, mononuclear phagocytes, and lactoferrin

Neonatal skin fibroblasts were cultured in supernatants of peripheral blood monocytes that had been cultured with and without lactoferrin. Granulocyte-monocyte colony-stimulating activity (CSA) was measured in supernatants of the fibroblast cultures with normal T lymphocyte-depleted, phagocyte-depleted, low density bone marrow target cells in colony growth (colony-forming unit granulocyte/macrophage) assays. Monocyte-conditioned medium contained a nondialyzable factor that enhanced by 17-50-fold the production of CSA by fibroblasts. The addition of lactoferrin to monocyte cultures reduced the activity of this monokine by 75-100%. Lactoferrin did not inhibit CSA production by monokine-stimulated fibroblasts. We conclude that under appropriate conditions human fibroblasts are potent sources of CSA, that the production of CSA by these cells is regulated by a stimulatory monokine, and that the production and or release of the monokine is inhibited by lactoferrin, a neutrophil-derived putative feedback inhibitor of granulopoiesis. We propose that the major role of mononuclear phagocytes in granulopoiesis is played not by producing CSA, but by recruiting other cells to do so, and that in the steady state, feedback regulation of neutrophil production may occur as a result of a mechanism that inhibits the recruitment phenomenon.

Lack of prostaglandin E2-mediated monocyte suppressive activity in newborn and mothers

An excess of adult blood adherent cells (monocytes) inhibits mitogen, antigen and allogeneic cell-induced lymphocyte proliferations. This inhibition is dependent on the number of the adherent monocytes in the cultures and is substantially reduced (by 60%) by indomethacin or anti-PGE2 antiserum. Newborn monocytes exert only a weak inhibitory effect and produce about eight times less PGE2 than adult monocytes. The production of PGE2 and the suppression can be induced by incubating newborn monocytes with mixed leucocyte culture supernatants. Both monocytes from mothers at the time of delivery and from newborn infants, usually exert a poor suppressive activity related to a low production of PGE2. We strongly suggest that the expression of the PGE2-mediated suppression by monocytes is under the control of activated short-lived suppressor lymphocytes.

The in vitro production of prostanoids by cultured bovine articular chondrocytes

Bovine articular chondrocytes, cultured as cell suspensions and monolayers, produced prostaglandin (PG) E2 and PGI2 (assayed as 6 keto PGF1 alpha), rather less PGF2 alpha and irregular quantities of thromboxane (Tx) B2. Addition of foetal calf serum to the medium greatly stimulated PG production (a sixfold increase in PGE2 and a twofold increase in 6 keto PGF1 alpha). Prostanoid production by cell suspensions grown in serum-free medium generally plateaued after 24 hours. In the presence of 20% foetal calf serum, prostanoid production in long-term monolayer cultures increased during the first 6 days of culture. Levels of PGE2 and TxB2 then decreased, while 6 keto PGF1 alpha levels remained high. Indomethacin (10(-6)M) inhibited chondrocyte PG production both in the presence and absence of added arachidonic acid (10(-4)M). Prostanoids produced by chondrocytes may play a role in the modulation of cartilage metabolism in vivo.

Fluid flow studies on vascular endothelium cultured on microporous membranes

We have designed a two compartment system in which upper and lower compartments are separated by a monolayer of vascular endothelial cells grown on a porous membrane. The culture of pig aortic endothelial cells and their growth to confluence on porous PTFE membranes is described, and the principal characteristics of membrane-cultured cells are compared with those of similar cells cultured on solid surfaces. A decrease in fluid flow across the membrane-cultured cells was associated with their growth to apparent confluence: from low levels, fluid flow could be increased markedly by altering the environmental temperature of the cells. The possible uses and limitations of such a system in the interpretation of the role of endothelial cells in selective transport and compartmentation of fluids and cellular components of the blood are discussed.