Ex vivo expansion of tumor-draining lymph node cells using compounds which activate intracellular signal transduction. I. Characterization and in vivo anti-tumor activity of glioma-sensitized lymphocytes

It has been shown that adoptive immunotherapy can be curative for established malignant tumors. The key to this treatment lies in obtaining sufficient numbers of lymphocytes which are sensitized to recognize tumor antigens and carry out immunological reactions to destroy tumor cells. Reported here are the results of experiments to: 1) sensitize lymphocytes to the antigens of rat glioma cells and expand them ex vivo for use in adoptive immunotherapy, 2) characterize the cells of the expanded population, and 3) evaluate antitumor activity in a cohort of rats with well-established intracranial gliomas. Viable RT-2 glioma cells were injected into the hind foot pads of syngeneic Fischer 344 rats. After 10 days, the tumor draining lymph nodes (DLN) were harvested from the injected limbs and mechanically dissociated. The cells of the DLN were then suspended in culture medium supplemented with low dose interleukin-2 (IL-2) and incubated for 18 hours with Bryostatin-1 and ionomycin (Bryo/Io) to stimulate expansion. The cells were next washed to remove the Bryo/Io and resuspended in culture medium and IL-2. Population expansions of 40- to 100-fold were seen after 8 days. Flow cytometric analysis showed these cells to be a nearly pure population of T lymphocytes of the CD3+CD8+ phenotype. Intravenous injection of the ex vivo expanded DLN cells did not significantly improve survival of rats with a seven-day intracerebral RT-2 glioma, although, compared to untreated controls, the tumors of the treated animals were smaller, showed no necrosis, and appeared to be less infiltrative. Furthermore, the treated animals had a pronounced lymphocytic infiltration of their tumors with greater associated degrees of hemorrhagic change and peritumoral edema. When the ex vivo expanded DLN cells were intravenously injected into three-day intracerebral RT-2 glioma models, tumors were almost always eliminated and the animals survived their tumor challenge. We conclude that successful expansion of glioma-sensitized DLN lymphocytes is possible and that adoptive immunotherapy using these cells is capable of effectively limiting the progression of large gliomas, while totally eradicating small ones.

Premicellar taurocholate enhances calcium uptake from all regions of rat small intestine

BACKGROUND/AIMS

The specific components of bile, which is necessary for normal calcium absorption, are unknown. We have previously shown that Ca2+ is bound with high affinity by premicellar taurocholate. The current studies examined the effects of taurocholate on intestinal calcium transport.

METHODS

Intestinal Ca2+ uptakes were measured from proximal, mid, and distal small intestinal segments perfused with solutions containing 45CaCl2 (0.1-1 mmol/L), taurocholate (0-10 mmol/L), trihydroxymethylaminomethane buffer (pH 7), phenolsulfonpthalein (nonabsorbable marker), and NaCl (total ionic strength, 0.16 mol/L) for four randomized perfusion periods. In other studies, the proximal small intestine was divided into two equal segments and perfused with either 45CaCl2 or 45CaCl2 plus taurocholate (2.5-5 mmol/L). Calcium absorption was measured from the difference in uptake and calcium concentration retained in mucosa. Finally, effects of taurocholate on Ca2+ uptake across isolated brush border membrane vesicles were measured.

RESULTS

Premicellar taurocholate produced an approximately 1.7-2-fold enhancement (P < 0.01) in Ca2+ uptake in all regions, with lesser contributions from micellar taurocholate. These effects resulted in a net increase in calcium absorption. Premicellar taurocholate also significantly increased calcium uptake across brush border vesicles.

CONCLUSIONS

Premicellar taurocholate significantly enhances calcium uptake into, and absorption across, enterocytes. The mechanisms remain to be experimentally verified.

Evidence that bile salts are important for iron absorption

The role of bile salts in intestinal Fe absorption has not previously been defined. We have recently shown that bile salts having cholanic ring 7 alpha-OH and/or 12 alpha-OH groups bind Fe2+ with high affinity at premicellar concentrations and also produce a two-to threefold enhancement in Fe2+ uptake from perfused intestinal segments in vivo. However, the physiological relevance of these observations for Fe2+ absorption was not known. To study this, we examined the effects of a single dose of taurocholate (TC) administered with 59Fe-FeSO4 in reversing iron malabsorption induced by bile duct ligation. Fe absorption from three 0.5-mg doses of 59Fe-FeSO4 was measured from five groups of six adult Sprague-Dawley rats each: group 1, before and after bile duct ligation and subsequent administration of 59Fe-FeSO4 + TC test dose; group 2, before and after bile duct ligation followed by a third dose of Fe alone; group 3, before and after bile duct ligation followed by a third dose of Fe+taurodehydrocholate (TDHC); group 4, sham laparotomy; and group 5, nonoperated controls where Fe absorption was measured from three doses of 59Fe-FeSO4 at the same time intervals as group 1. Absorption was measured, using whole body counting, after achievement of steady-state counts after each Fe dose. Mean percentage absorption from dose 1 (baseline) was 35.33 +/- 4.6% (SE). No significant differences between any groups were noted. In nonoperated controls (group 4), Fe absorption was virtually identical after all three doses. Also, hematocrit did not change in any of the 30 animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Clearance of 131I by hemodialysis

There are no available data documenting the dialysis clearance of iodide in humans. This work quantitates the hemodialysis clearance of iodide (as 131I) over time and examines certain factors which influence that clearance. In a single-patient study, three dialysis periods were studied over the 24 to 96 hours following administration of 129 mCi 131I given as Na131I. Hemodialysis clearance of 131I was calculated both from the arterio-venous difference of 131I across the artificial kidney and the appearance of 131I in the expended dialysate. Calculations were based on 131I activity in whole blood, whole plasma, and the supernate of plasma treated with 10% trichloroacetic acid (TCA). The hemodialysis clearance of 131I was highest when calculated from the activity of the plasma supernate, 171.3 +/- 6.0 ml/min for the period 24-29 h. post dosing, and fell in a linear fashion with time. The clearance calculated from whole blood activity was always intermediate to that from whole plasma (lowest) or the plasma supernate (highest). The percentage of plasma 131I activity precipitated by TCA rose over the study period and displayed a strong negative correlation to the hemodialysis clearance of 131I. The hemodialysis clearance of iodide, as 131I, is on the order expected for a free ion and is 4-5 times higher than the endogenous renal clearance of the ion. However, the calculated clearance varies with respect to total time of dialysis and the fraction of blood in which the 131I activity is measured.(ABSTRACT TRUNCATED AT 250 WORDS)

High-affinity binding is essential for enhancement of intestinal Fe2+ and Ca2+ uptake by bile salts

Both calcium and iron are bound with high affinity by premicellar bile salts having cholanic ring 7-OH and/or 12-OH groups, forming soluble cation-bile salt complexes. The authors of the current study recently showed that premicellar taurocholate markedly enhances intestinal iron and calcium uptake. However, the relationship of high-affinity binding to the observed uptake enhancement was unknown. In the current study, this relationship was examined by studying taurodehydrocholate (TDHC) binding and intestinal uptake of both cations. Ca2+ binding was measured by noting depression of [Ca2+] activity in solutions containing constant total Ca concentrations (1 mmol/L) and varying [TDHC] (0.5-50 mmol/L). Fe2+ binding was assessed by equilibrium dialysis studies of 59FeSO4 (0.179-1.79 mmol/L) and TDHC (0.5-50 mmol/L). Effects of TDHC on intestinal Fe2+ and Ca2+ uptake were measured in isolated perfused intestinal segments in vivo in seven and eight Sprague-Dawley rats, respectively. TDHC, lacking ring OH groups, did not bind either cation with high affinity and had no effect on their intestinal uptake. These results suggest that high-affinity binding is essential for bile salt-induced enhancement of intestinal Fe2+ and Ca2+ uptake.

Refillable point source for motion correction during first-pass radionuclide angiography

First-pass radionuclide angiography, for the evaluation of ventricular function during peak physiological stress, requires the use of a low-energy point source for correction of motion artifacts. A design for the construction of a refillable 125I point source is presented.

Increased morbidity with increased pulmonary albumin flux in sepsis-related adult respiratory distress syndrome

OBJECTIVE

To determine the feasibility of utilizing a scintigraphic technique to differentiate patients with adult respiratory distress syndrome due to sepsis syndrome from control volunteers and patients with congestive heart failure. Gamma scintigraphy was compared with chest roentgenograms to predict mortality rate and morbidity in adult respiratory distress syndrome (ARDS) patients.

DESIGN

Prospective study.

SETTING

University hospital ICUs.

PATIENTS

Thirty-five control volunteers, 19 patients with congestive heart failure, 30 patients with a diagnosis of sepsis.

MEASUREMENTS AND MAIN RESULTS

All patients were infused iv with technetium 99m-labeled albumin and underwent computerized gamma-scintigraphic analysis with a portable gamma camera. Lung-to-heart ratio of tracer was calculated and expressed as the slope index. Increase in slope index indicated increased pulmonary albumin flux. Slope index was no different in controls compared with congestive heart failure patients, unless the pulmonary artery occlusion pressure (PAOP) was greater than 30 mm Hg. Patients with a diagnosis of sepsis had an overall increased slope index compared with the other groups. A subgroup of patients in the septic group had a normal slope index. Septic patients with an increased slope index had a significantly (p less than .01) longer duration of mechanical ventilation (36 +/- 5 vs. 7 +/- 1 days), spent longer in the ICU (67 +/- 9 vs. 11 +/- 1 days), and had a longer hospital stay (113 +/- 20 vs. 35 +/- 5 days) than septic patients with a normal slope index.

CONCLUSIONS

Gamma scintigraphy successfully differentiated between control volunteers and patients with congestive heart failure with PAOP less than 30 mm Hg from patients with sepsis-induced ARDS. Although all of the patients with a clinical diagnosis of septic ARDS had similar impairments in oxygenation and chest roentgenograms, those patients with a significantly increased pulmonary albumin flux (greater than 2 SD above control mean) had a markedly increased morbidity.

Differentiation of reperfused-viable (stunned) from reperfused-infarcted myocardium at 1 to 3 days postreperfusion by in vivo phosphorus-31 nuclear magnetic resonance spectroscopy

Thrombolytic therapy has increased the need for a technique to assess the viability of recently reperfused myocardium. This study examined the ability of in vivo phosphorus-31 (P-31) nuclear magnetic resonance (NMR) spectroscopy to distinguish reperfused-viable (stunned) from reperfused-infarcted myocardium at 6, 30, and 54 hours following coronary artery occlusion in a canine model. A 15-minute occlusion produced reperfused-viable myocardium in five animals and a 360-minute occlusion produced reperfused-infarcted myocardium in six animals. Postreperfusion risk zone myocardial phosphocreatine (PCr) concentration measured by P-31 NMR spectroscopy was significantly depressed throughout the 3-day study period in infarcted but not in viable myocardium (p less than 0.01 between groups, all time points). The postreperfusion ratio of inorganic phosphate (Pi) to PCr concentration, as determined by NMR spectroscopy, was elevated throughout the study period in infarcted but not in viable reperfused myocardium (p less than 0.01 between groups, all time points). Postreperfusion Pi concentration was elevated at 6 hours but not subsequently in reperfused-infarcted myocardium, and was not elevated in reperfused-viable myocardium. Logistic regression models selected PCr concentration and the Pi/PCr ratio as providing the best discrimination between reperfused-viable and reperfused-infarcted myocardium. The accuracy of P-31 NMR variables selected by logistic regression analysis for determining myocardial viability ranged from 97% to 100%.

Effect of brief regional ischemia followed by reperfusion with or without superoxide dismutase and catalase administration on myocardial sarcoplasmic reticulum and contractile function

The effect of reperfusion with and without free radical scavengers on sarcoplasmic reticulum and contractile function was examined in a canine model of 15-minute coronary artery occlusion followed by reperfusion. Dogs were reperfused with (n = 13) or without (n = 16) superoxide dismutase and catalase or were killed at 15 minutes of ischemia (n = 17). Superoxide dismutase and catalase were administered as a bolus (20,000 and 12,500 U/kg, respectively) beginning 1.25 minutes before reperfusion followed by infusion of 16,000 and 12,500 U/kg/hr, respectively. Sarcoplasmic reticulum function was evaluated from the rate of calcium uptake of unfractionated subepicardial, subendocardial, and transmural homogenates determined with and without ruthenium red to close the calcium release channel. Mechanical function was evaluated by means of sonomicrometry. Fifteen minutes of ischemia significantly (p less than 0.05) depressed the sarcoplasmic reticulum calcium uptake rate only in the subendocardium (from 25 +/- 2 to 14 +/- 1 nmol/min/mg without ruthenium red and from 60 +/- 3 to 49 +/- 3 nmol/min/mg with ruthenium red). Reperfusion with or without superoxide dismutase and catalase restored homogenate calcium uptake rates to normal, although severe contractile dysfunction persisted. This indicates that damage to the sarcoplasmic reticulum may not be the major cause of postreperfusion contractile dysfunction. Ischemia-reperfusion caused a decrease in systolic shortening from 19 +/- 2% to 1 +/- 2% with and from 18 +/- 1% to 4 +/- 1% without free radical scavengers (p = NS between groups). Thus administration of superoxide dismutase and catalase beginning shortly before reperfusion had no effect on postreperfusion contractile dysfunction or sarcoplasmic reticulum function.

Premicellar taurocholate enhances ferrous iron uptake from all regions of rat small intestine

Inorganic iron is virtually insoluble at the pH of small intestinal contents. This severe solubility limitation has been partly overcome by intraluminal substances that bind and solubilize iron, thus increasing availability for absorption. While several dietary ligands capable of solubilizing Fe2+ in intestinal lumen have been described, an endogenous binding ligand has not been previously described. It has recently been shown that certain trihydroxy bile acids (taurocholate and glycocholate) show high-affinity premicellar and low-affinity micellar Fe(2+)-binding properties, resulting in the formation of soluble Fe(2+)-bile salt complexes. It was hypothesized that this binding would increase the intraluminal pool of soluble iron, increase delivery of soluble iron to mucosal carriers, and thus enhance intestinal Fe2+ uptake. As a first step toward testing this hypothesis, the effect of taurocholate on Fe2+ uptake from all regions of in vivo rat small intestine is reported. It is shown that taurocholate, at premicellar concentrations, produces a marked, stepwise increase in Fe2+ uptake from all regions of small bowel, with little further increase above the critical micellar concentration. Enhancement of intestinal Fe2+ uptake is a newly described effect, and potential physiological function, of premicellar bile salts.

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)

Pulmonary compliance: early assessment of evolving lung injury after onset of sepsis

We compared the sensitivity of dynamic (Cdyn) and static lung compliance (CL) with indicators of permeability injury in a model of septic porcine adult respiratory distress syndrome. Two groups of anesthetized ventilated swine (15-25 kg) were studied. Septic animals (Ps, n = 13) received Pseudomonas aeruginosa intravenously for 1 h, which resulted in severe adult respiratory distress syndrome. Controls (C, n = 13) received 0.9% NaCl. Cdyn, CL, bronchoalveolar lavage for protein estimation, and thermal cardiogreen extravascular lung water (EVLW) measurements were performed in seven C and eight Ps animals. Six C and five Ps animals underwent gamma camera measurement of lung-to-heart ratio (slope index) of 99Tc-labeled human serum albumin. Both Cdyn and CL decreased significantly (P less than 0.01) at 30 min and thereafter in Ps vs. C. EVLW, slope index, and bronchoalveolar protein content increased significantly (P less than 0.05) in Ps vs. C at 120, 150, and 300 min, respectively. Cdyn and CL decreased well before onset of permeability injury. These early changes may be due to release of vasoactive mediators and sequestration of neutrophils in the pulmonary capillaries and later to increases in EVLW. Measurement of Cdyn and CL represents an early means of assessing evolving lung injury in this acute septic porcine model.

Premicellar taurocholate avidly binds ferrous (Fe++) iron: a potential physiologic role for bile salts in iron absorption

Two of the major divalent cations in human physiology, Ca++ and Fe++, are poorly soluble at the pH of intestinal contents, and active "uphill" transport mechanisms exist for both ions in proximal small intestine. We have recently demonstrated significant binding of Ca++ to both premicellar and micellar bile salts and have postulated that high-affinity premicellar binding involves interposition of Ca++ between terminal carboxyl (COO-) and 7-OH or 12-OH groups of the steroid ring. The present studies were made to determine whether such binding extends to other divalent cations, and specifically to Fe++, which, like Ca++, has a hydrated diameter of 6 A. Equilibrium dialysis studies of sodium taurocholate were made at 25 degrees C with solutions containing 0.5 to 150 mmol/L taurocholate and 0.018 to 1.8 mmol/L iron 59-labeled FeSO4 at pH 3.0 to 6.3 and a total ionic strength of 0.15 mol/L. In control (saline dialysand) cells, [Fe++] was virtually equal in dialysands and dialysates within 5 hours. In sharp contrast, taurocholate-containing dialysands showed significantly higher counts than dialysates, indicating Fe++ binding to taurocholate, independent of pH and Fe concentration. After correction for taurocholate-induced Gibbs-Donnan effects across the membrane, the apparent taurocholate affinity constant (K'f) for Fe++ in micellar solutions (5 to 150 mmol/L) was essentially constant at about 3.1 (mol/L)-1, then increased dramatically below the critical micellar concentration to greater than 100 (mol/L)-1 at [taurocholate] = 0.5 mmol/L. The hyperbolic rise in K'f below the critical micellar concentration is similar to that which we have previously reported for Ca++, indicating significant high-affinity binding of Fe++ to premicellar taurocholate anions and low-affinity binding to micellar anions. It is postulated that Fe++ binding, particularly by premicellar bile salts, may play an important physiologic role in increasing iron solubility within the intestinal lumen, thus increasing iron absorption. The possible role of bile salts in increasing divalent cation solubility and absorption from the intestine is a new field of bile acid research.

Persistent splenic visualization on technetium-99m DISIDA hepatobiliary studies

Tc-99m DISIDA is widely used for studying a variety of biliary conditions. It is generally recognized that the spleen is normally visualized on DISIDA imaging only during the blood pool phase. Upon review of our experience with DISIDA, visualization of the spleen was found more common than generally acknowledged. All DISIDA examinations performed at our two institutions were retrospectively reviewed; 95 studies were performed at Institution #1 and 150 studies at Institution #2. There were 138 men and 107 women. Quality control to confirm radiochemical purity included sephadex gel column chromatography. Of 245 patient studies, persistent splenic visualization was identified in one patient (1.0%) at Institution #1 and in 11 patients (7.3%) at Institution #2. There was no correlation between age, sex or final diagnosis and persistent visualization of the spleen. It is suggested that persistent splenic visualization may be caused by an elevated concentration of reduced hydrolized technetium (colloid) in DISIDA.

Reperfused-viable and reperfused-infarcted myocardium: differentiation with in vivo P-31 MR spectroscopy

The ability of in vivo phosphorus-31 magnetic resonance (MR) spectroscopy to permit accurate distinction between reperfused-viable and reperfused-infarcted myocardium was examined in a canine model of acute coronary occlusion. In vivo myocardial pH and phosphocreatine, adenosine triphosphate, and inorganic phosphate levels were measured at baseline and for the first 90 minutes after reperfusion of a total coronary artery occlusion producing either predominantly viable (nine animals) or infarcted (nine animals) myocardium in the region of metabolic study. Myocardial viability was assessed in each animal by means of postmortem triphenyltetrazolium chloride staining. Tissue was characterized from the in vivo P-31 MR data by means of logistic regression analysis. The accuracy of using the P-31 MR data for distinguishing reperfused-viable from reperfused-infarcted myocardium was 100% (69 of 69 data points, 18 of 18 animals). Results of the logistic regression procedure indicated that phosphocreatine was the metabolic variable enabling most effective separation of reperfused-viable and reperfused-infarcted myocardium. Thus, metabolic data obtained with P-31 MR spectroscopy permit effective separation of reperfused-viable from reperfused-infarcted myocardium.

Preparation and evaluation of a 99mTc-SnF2 colloid kit for leukocyte labeling

Stannous fluoride colloid (SFC) kits for instant radiolabeling with 99mTc were prepared and evaluated for suitability as a leukocyte radiolabeling agent. Technetium-99m labeling for kits stored at -15 degrees C for up to 3 mo was greater than 95% as determined by instant thin layer chromatography while colloid particles of 1-3 microns were measured by electron microscope for these preparations. Canine leukocyte preparations labeled with [99mTc]SFC and characterized by triple density gradients of metrizamide in plasma demonstrated an 83% leukocyte association. Analysis of labeled cell preparation for up to 3 hr demonstrated label stability. Labeled leukocytes, when readministered in normal dogs, demonstrated bi-exponential blood clearance with uptake and subsequent clearance from lung. There was increasing uptake of labeled leukocytes by the liver until steady state was achieved. Furthermore, when whole blood samples were analyzed by the triple density gradient method, an increasing monocyte-to-granulocyte ratio was observed to occur with time. By 3 hr 95% of the whole blood activity was associated with the leukocyte fraction. Dogs in which a 24-hr sterile abscess was created demonstrated elevated blood-pool activity as compared to control with localization of the labeled cells at inflammatory sites within 3 hr following cell readministration.

Effect of methylene blue on estrogen-receptor activity

Methylene blue in a 1% sterile solution for injection to help localize occult breast tumor was shown to interfere with the estrogen-receptor protein (ERP) binding-capacity assay. Cytosols derived from ERP-positive lyophilized powders and human breast tissue were evaluated with and without varying levels of treatment with methylene blue. Cytosols treated with 0.1% methylene blue, a clinically significant level, demonstrated a substantially lower ERP binding capacity compared with control cytosols. This alteration was found to be due to a reduction in specific binding capacity and not to an alteration in apparent cytosol protein concentration. The use of methylene blue for occult breast tumor localization is not recommended when an ERP binding-capacity assay is anticipated.

Noninterference of isosulfan blue on estrogen-receptor activity

Because a 1% sterile solution of methylene blue used for occult breast tumor localization has been shown to interfere with the estrogen-receptor protein (ERP) binding-capacity assay, isosulfan blue in a 1% injection was studied as a potential alternate stain. Cytosols derived from ERP-positive lyophilized powders and human breast tissue were evaluated with and without varying levels of treatment with isosulfan blue. No modification of the ERP-specific binding capacity was found with this stain. The use of isosulfan blue for localization of occult breast tumor is suggested when an ERP binding capacity assay is anticipated.

Significance of alteration in biodistribution of labeled lymphocytes exposed to stannous ion

The biodistribution patterns of 99mTc (99mTc-lymph) and 111In-lymphocytes with [111In-(Sn)-lymph] or without (111In-lymph) stannous ion treatment was compared in Lewis rats. Syngeneic lymphocytes were labeled with either 125 microCi (4.63 MBq) 99mTc or 5 microCi (185 kBq) 111In per 2 x 10(7) cells. Mean labeling efficiency for 99mTc and 111In was 68.61% +/- 3.90% (SEM) and 87.22% +/- 2.01% (SEM) respectively. 99mTc-lymph (n = 4), 111In-lymph (n = 6) and 111In-(Sn)-lymph (n = 6) rats received 2 x 10(7) cells and were killed 18 h later. While 99mTc-lymph demonstrated significantly less localization in spleen, lymph nodes, and blood (P(F) less than 0.01) as compared with 111In-lymph, 111In-(Sn)lymph also demonstrated a significant difference (P[F]= 0.0001) in lymph node accumulation when compared to 111In-lymph. As the activity levels utilized are not associated with cell radiation damage, these alterations in biodistribution do not reflect viability or chromosomal damage, but appear related to stannous ion exposure.

Effective separation of normal, acutely ischemic, and reperfused myocardium with P-31 MR spectroscopy

The ability of phosphorus-31 magnetic resonance (MR) spectroscopy to accurately characterize myocardium as normal, ischemic, or reperfused but viable was examined in the canine model of acute coronary artery occlusion. P-31 MR measurements of in vivo myocardial pH, phosphocreatine, adenosine triphosphate, and inorganic phosphate levels were made at baseline and for 6 hours after sustained coronary occlusion (ten animals) or coronary occlusion reperfused after 60 minutes (12 animals). Ten control animals were studied in parallel fashion, without coronary occlusion. Myocardial tissue characterization derived from the P-31 MR spectroscopy data by logistic regression analysis had an overall accuracy of 89%. Overall accuracy was unaffected by duration between coronary occlusion and P-31 MR study. Thus, metabolic data obtained with P-31 MR spectroscopy effectively separate normal, acutely ischemic, and reperfused but viable myocardium.

Effects of ibuprofen on a pig Pseudomonas ARDS model

The effects of ibuprofen (I) were studied in the Pseudomonas (P) porcine ARDS model. Pigs, 14-26 kg (5 in each group), were anesthetized and ventilated with 0.5 FiO2 and 5 cm H2O PEEP. A control (C) group received saline only, a second group was given P, 1 X 10(8) org/ml at 0.3 cc/20 kg/min, and a third group was given P followed by 12.5 mg I at 20 and 120 min. Pulmonary arterial (PAP), wedge (PWP) and systemic arterial pressures, cardiac output (CO), and thermal-cardiogreen extravascular lung water (EVLW), thromboxane (TxB2), 6-keto-PGF1 alpha, PaO2, PaCO2 were determined every 30 min. Albumin flux was measured with scintigraphic determination of lung:heart radioactivity ratios versus time, called slope index (SI). At 3 hr, P produced marked (P less than 0.05) increases in PAP (18 +/- 7 to 37 +/- 2 mm Hg), TxB2 (471 +/- 513 to 9216 +/- 3615 pg/ml), 6-keto-PGF1 alpha, EVLW (6.4 +/- 1.4 to 14.6 +/- 5.7 mg/kg), and SI (0.4 +/- 0.2 to 1.7 +/- 0.5 X 10(-3) U/min) with decreases in PaO2 (214 +/- 47 to 101 +/- 41 torr), CO and SAP. Ibuprofen caused a rapid clearing of TxB2 and 6-keto-PGF1 alpha associated with a transient decrease in PAP; PaO2 was considerably improved compared to P; however, CO, SAP, EVLW, and SI were unaffected. Prostaglandin blockage temporarily ameliorated the pulmonary hypertension and markedly improved oxygenation in this porcine septic ARDS model, but failed to alter increased permeability, confirming other studies that the increased pulmonary shunt in ARDS is not only dependent upon capillary leak.

Comparison of indium 111-labeled platelets v leukocytes in a pyogenic abscess

This study sought to determine which blood component, WBCs or platelets, is the more specific indicator of an abscess and where each localizes. An abscess was created using stool in the hind limb of dogs. After 24 hours, one group was given autologous indium 111-labeled platelets and another group was given autologous indium 111-labeled WBCs. Blood, abscess fluid, infected operative control muscle tissue, and nonoperative control muscle tissue were counted for radioactivity 24 hours after administration of the labeled cells. There was significantly (P less than .001) less WBC radioactivity in blood and more within abscess fluid compared with platelets. The highest platelet activity occurred in muscle tissue adjacent to the abscess (P less than .002) compared with platelet activity in abscess fluid or control muscle tissue. The unwanted high platelet blood background activity and the desirable high concentration of WBC radioactivity within the abscess fluid makes the latter the preferential radionuclide imaging agent.

Artifactual focal accumulation of Tc-99m bone imaging tracer in the chest. Technical note (bone imaging artifact)

Four patients undergoing routine bone imaging with a Tc-99m bone imaging agent were observed to have multiple focal areas of increased uptake in the lungs. Delayed or repeat examination demonstrated resolution of the areas. The authors conclude that this was an isolated and bizarre case of aggregate formation.

Failure of methylprednisolone, ibuprofen, or prostacyclin to reduce HCl-induced pulmonary albumin leak in dogs

The purpose of this study was to examine the effects of methylprednisolone (MP), ibuprofen (I), and prostacyclin (PGI2) pretreatment on cardiopulmonary hemodynamics, arterial oxygenation, and pulmonary alveolar-capillary membrane permeability, measured with a gamma-scintigraphic technique, after acid instillation in the dog. All animals were placed on their right side and 2 ml/kg 0.1 N HCl was instilled into the endotracheal tube. Five untreated control dogs showed a significant (p less than 0.05) rise in slope index (SI), a scintigraphic measurement of pulmonary albumin flux, 30 minutes after acid injury. After 120 minutes there was a significant rise in mean pulmonary arterial pressure (PAP) and pulmonary vascular resistance (PVR) and a decrease (p less than 0.05) in cardiac output (CO) and PaO2. Two groups of five dogs each were pretreated with MP (30 mg/kg) and I (12.5 mg/kg), respectively. Thirty minutes after acid instillation both groups showed a significant rise in the SI, which was significantly greater than the values in the control animals in the case of MP. By 120 minutes after acid injury all changes in PAP, PVR, PaO2, and CO were not significantly different from those of control animals with the exception of the I group, which resisted any change in CO throughout the study. Another group of five dogs were pretreated with a constant infusion of PGI2 (3 micrograms/kg/min) starting 75 minutes before acid instillation. PGI2 produced a significant increase in CO that was also greater (p less than 0.05) than the CO in control animals before instillation of HCl. Pre-HCl SI in the dogs treated with PGI2 was slightly, but significantly, increased over control dogs. The SI and CO remained significantly higher than values in control animals 30 minutes after acid injury. The SI remained significantly higher than that of control animals at 120 minutes. After 2 hours changes in PAP, PVR, PaO2, and CO were without significant difference from those of control animals. These data support the conclusion that PGI2, I, or MP are not effective therapy for acid aspiration and that PGI2 and I may worsen the protein leak by increasing flow across the damaged capillary membrane.

Pitfall to modified in vivo method of technetium-99m red blood cell labeling. Iodinated contrast media

Suboptimal labeling of red blood cells with Tc-99m, using the modified in vivo technique, was observed in three patients in whom labeling was attempted following IV administration of iodinated contrast media in the previous 24 hours. The mechanism is not understood, but it may represent a change in either stannous ion distribution or redox potential. It is recommended that studies employing Tc-99m RBC labeling using this technique be performed prior to administration of iodinated contrast media. This effect should be kept in mind in gastrointestinal bleeding studies performed using Tc-99m RBC, as well as in cardiac imaging studies.

Failure of various agents to decrease oleic acid pulmonary albumin leak

Computerized pulmonary gamma scintigraphy has been shown to be a sensitive technique for the measurement of albumin flux in oleic acid pulmonary microvascular injury. In this technique technetium-99m-tagged human serum albumin is administered intravenously and lung:heart radioactivity ratios are constructed. This ratio remains constant unless there is a net flux of albumin from the vascular space into the lung, when a rising ratio is seen, called the "slope of injury" or SI. Gamma scintigraphy provides a method to rapidly screen the ability of various possible therapeutic agents to reduce the flux of albumin in experimental ARDS. In this study, 0.05 ml/kg oleic acid produced a significant increase in the SI. None of the agents tested (30 mg/kg methylprednisolone, 12.5 mg/kg ibuprofen, 4 mg/kg MK-447, a superoxide radical scavenger, or 140 mg/kg calcium gluconate) were able to alter the scintigraphically measured increased albumin flux produced by 0.05 ml/kg oleic acid.

Gamma scintigraphic localization of platelets labeled with indium 111 in a focus of infection

To determine if autologous platelets would localize in a focus of infection, a pyogenic abscess was created in the left hind limb of dogs, using previously processed human stool, while an identical surgical procedure without bacterial inoculation was performed on the right hind limb. Autologous platelets labeled with indium 111 (500 microCi) were administered intravenously to five control dogs that had not undergone surgery, to eight dogs two hours following stool inoculation, and to five dogs 24 hours after stool inoculation. A statistically significant scintigraphic increase in tracer activity was apparent within 24 hours in each animal at the site of abscess creation. Tissue samples, obtained at 48 hours after the administration of labeled platelets, revealed a significant increase in percent dose of 111In per gram of infected muscle compared with control muscle. These studies show that platelets localize at the site of bacterial infection.

Use of isosulfan blue for identification of lymphatic vessels: experimental and clinical evaluation

Use of vital dyes for identification of lymphatic vessels before cannulation has heretofore not been approved by the Food and Drug Administration (FDA). The suitability of isosulfan blue, the 2,5 disulfonic acid isomer of Patent Blue, for this purpose was evaluated experimentally in the rat and clinically in 11 volunteers and 543 patients under an investigational new drug application. FDA approval for this drug has been obtained. Volunteers and patients received up to 15 mg of a 1% sterile, pyrogen-free solution per extremity (total dose of 0.4 mg/kg in the average patient). Excellent identification of lymphatic vessels was achieved in 100% of volunteers and in 97.4% of patients. In the other 2.6%, lymphatic vessels were not identified mainly due to congenital lymphatic vascular (Milroy) disease. Baseline blood chemistry in volunteers was not altered after administration of the dye. No adverse reactions were found in volunteers and minimal allergic reactions occurred in less than 1% of patients. Acute toxicity studies demonstrated an LD50 greater than 150 mg/kg in the rat. Isosulfan blue was excreted unchanged in the urine (7%) and feces. Comparable excretion was found in volunteers. Isosulfan blue is a safe and efficacious vital dye for lymphangiography.

Computerized scintigraphic technique for the evaluation of adult respiratory distress syndrome: initial clinical trials

Eleven patients with suspected adult respiratory distress syndrome (ARDS) and five control patients were studied using a computerized gamma imaging and analysis technique and 99mTc-labeled human serum albumin. The heart and right lung were imaged, lung:heart ratio was plotted vs. time, and a linear regression was fitted to the data points displayed. The slope of this fit was termed the "slope index." An index value of 2 standard deviations greater than the control mean was considered positive. Radiographs from the six positive studies revealed typical diffuse air-space disease. Radiographs from two of the five negative studies demonstrated air-space consolidation. Both of these patients had elevated pulmonary capillary wedge pressure, cardiomegaly, and clinical course consistent with cardiogenic pulmonary edema. These preliminary data demonstrated a good correlation between positive slope index and clinical ARDS.

Scintigraphy and radiography in oleic acid pulmonary microvascular injury: effects of positive end-expiratory pressure (PEEP)

Using computerized gamma scintigraphy, 10-cm H2O PEEP did not alter the rate of capillary protein leakage in dogs following pulmonary microvascular injury with 0.01 to 0.2 ml/kg oleic acid. A rising lung:heart radioactivity ratio, or 'slope of injury,' was seen during PEEP which paralleled the 'slope of injury' had PEEP not been used. A sudden decrease in lung and heart count activity (p less than 0.001) and decreased lung:heart radioactivity ratio (p less than 0.001) occurred with PEEP at all doses of oleic acid studied. An apparent improvement in the standard chest roentgenogram was seen within 2 minutes following PEEP in dogs given 0.2 ml/kg oleic acid. However, progression of the radiographic infiltrate occurred in these animals during 30 minutes of PEEP. When all vessels leading to and from the heart and lungs were ligated, PEEP produced a 60% fall in count activity over the lung without any change in cardiac radioactivity. The apparent radiographic improvement and 2/3 of the fall in lung radioactivity with PEEP were due to an increased pulmonary air volume and 1/3 due to a decreased pulmonary blood volume. The decreased cardiac output with PEEP must be secondary to decreased ventricular filling rather than decreased ventricular function.

Comparative scintigraphy in oleic acid pulmonary microvascular injury

Computerized gamma scintigraphy revealed a significant (p less than 0.001) rising lung:heart radioactivity ratio, which has been called "slope of injury" or "slope index", with both 99mTechnetium-tagged human serum albumin (99mTc-HSA) and 99mTechnetium-tagged red blood cells (99Tc-RBC) after 0.05 or 0.2 ml/kg iv oleic acid administration to dogs. This slope index was significantly greater with 99mTc-HSA than 99mTc-RBC (p less than 0.001). These findings verify that the scintigraphic 99mTc-HSA slope of injury is a result of a pulmonary capillary protein leak and not oleic acid induced changes in pulmonary blood or air volume. The leak of red blood cells noted with scintigraphy was confirmed by light microscopy and examination of the tracheal edema fluid. The leak of albumin, however, was much greater than the leak of red blood cells by microscopy and tracheal fluid examination, confirming the scintigraphic data. This study provides further evidence that computerized gamma scintigraphy will be of value for the diagnosis of permeability pulmonary edema and its response to treatment.

Single isotope evaluation of pulmonary capillary protein leak (ARDS model) using computerized gamma scintigraphy

Using a canine oleic acid model, a computerized gamma scintigraphic technique was evaluated to determine 1) ability to detect pulmonary capillary protein leak in a model temporally consistent with clinical adult respiratory distress syndrome (ARDS), 2) the possibility of providing a quantitative index of leak, and 3) the feasibility of closely spaced repeat evaluations. Study animals received oleic acid (controls, n = 10; 0.05 ml/kg, n = 10; 0.10 ml/kg, n = 12; 0.15 ml/kg, n = 6) 3 hours prior to a tracer dose of technetium-990m (99mTc) HSA. One animal in each dose group also received two repeat tracer injections spaced a minimum of 45 minutes apart. Digital images were obtained with a conventional gamma camera interfaced to a dedicated medical computer. Lung: heart ratio versus time curves were generated, and a slope index was calculated for each curve. Slope index values for all doses were significantly greater than control values (P(t) less than 0.0001). Each incremental dose increase was also significantly greater than the previous dose level. Oleic acid dose versus slope index fitted a linear regression model with r = 0.94. Repeat dosing produced index values with standard deviations less than the group sample standard deviations. We feel this technique may have application in the clinical study of pulmonary permeability edema.

Effects of pulmonary vascular recruitment on gamma scintigraphy and pulmonary capillary protein leak

Pulmonary vascular recruitment (PVR) was altered and lung-heart radioactivity ratio (L:H) measured using 99mTc-tagged human serum albumin (Tc-HSA) in five dogs each by inflating a left atrial balloon (LAB) to produce a 20 mm Hg pulmonary capillary wedge pressure (PCWP) or opening a 5 mm diameter aortoinferior caval shunt (ACS) before and after oleic and injury. Cardiac output (CO), pulmonary arterial pressure (PAP), and PCWP were measured with each alteration in PVR. In an additional 10 dogs, multiple doses of Tc-HSA, administered over 5 hours, 2 hours after 0.1 ml/kg oleic acid, produced parallel "slopes of injury" over the 5-hour period. Each rise in PVR was associated with an acute increase in L:H but demonstrated no significant increase in slope after equilibration. Closure of the ACS or LAB deflation returned the L:H to projected baseline. A "slope of injury" (P less than 0.001) was seen after the administration of oleic acid, which was significantly (P less than 0.01) steeper with an increased PVR. This was confirmed by repeat doses of Tc-HSA. This study confirmed the following hypotheses: (1) the "slope of injury" curves were reproducible so that the effects of experimental interventions on the rate of protein leak could be determined; (2) the L:H rapidly became constant after an acute change in PVR prior to oleic acid injury: and (3) a raised PVR would increase the rate of albumin leak after pulmonary microvascular injury.

Sensitivity of scintigraphy for detection of pulmonary capillary albumin leak in canine oleic acid ARDS

Computerized gamma scintigraphy was shown in this study to be a sensitive technique for the detection and kinetic analysis of a pulmonary capillary protein leak. A rising lung:heart radioactivity of 'slope of injury' was found at each dose of intravenous oleic acid in dogs from 0.01 to 0.20 ml/kg (p less than 0.01). This 'slope of injury' was proportional to the dose of oleic acid (r = +0.97; p less than 0.004) and was more sensitive than changes in arterial oxygen tension, standard chest radiography, bloodless wet:dry lung weight, or alveolar epithelial membrane permeability. Only standard light microscopy and right lymphatic duct flow were able to document the leakage of protein detected by gamma scintigraphy at 0.01 ml/kg oleic acid.

Insulin adsorption to polyolefin infusion bottles and polyvinyl chloride administration sets

The availability of various dosages of insulin from a new collapsible polyolefin bottle fitted with a conventional polyvinyl chloride administration set was studied. Intravenous solutions containing various dosages of insulin (20, 40, 70, and 100 units), to which 125I-labeled insulin was added, were prepared. Solutions were mixed and delivered at a maintained flow rate of 125 ml/hour. Effluents were collected at 15, 30, 45, and 60 minutes and then at hourly intervals up to seven hours. One-milliliter samples were drawn from the end of the administration set at the end of each interval, and the level of radioactivity in the sample was measured. Greater percentages of binding occurred at the lower levels of insulin added. Saturation limits of 7.8, 2.7, and 5.4 units were found for the system, administration set, and bottle, respectively. Adsorption values for this bottle were less than that found in another study for polyvinyl chloride.

Allergic reaction to Patent Blue Violet during lymphography

A case of an allergic reaction to Patent Blue Violet dye used for the purpose of lymphangiography is reported. The clinical findings were urticarial reaction, edema of the eyelids and lips, and hypotension. Previous sensitization to triphenylmethane dyes, in drugs and other chemicals was likely, but not proven. Such commonly used compounds have been compiled in a Table. History of a previous hypersensitivity reaction to these compounds is not a contraindication for lymphangiography but should call for emergency planning and possible premedication.

Localization of the renal cortical imaging agent 99mTc-Sn-DMSA in the bowel

Renal imaging in 2 patients with severe renal disease (serum creatinine greater than 10 mg/dl) showed deposition of 99mTc-Sn-DMSA in the bowel. Like 203 Hg-chlormerodrin, this radionuclide may be associated with a hepatobiliary excretory mechanism in patients with renal impairment.