Robust T cell responses to aspergillosis in chronic granulomatous disease: implications for immunotherapy.

Chronic granulomatous disease (CGD) patients are highly susceptible to invasive aspergillosis and might benefit from aspergillus-specific T cell immunotherapy, which has shown promise in treating those with known T cell defects such as haematopoietic stem cell transplant (HSCT) recipients. But whether such T cell defects contribute to increased risks for aspergillus infection in CGD is unclear. Hence, we set out to characterize the aspergillus-specific T cell response in CGD. In murine CGD models and in patients with CGD we showed that the CD4(+) T cell responses to aspergillus were unimpaired: aspergillus-specific T cell frequencies were even elevated in CGD mice (P < 0·01) and humans (P = 0·02), compared to their healthy counterparts. CD4-depleted murine models suggested that the role of T cells might be redundant because resistance to aspergillus infection was conserved in CD4(+) T cell-depleted mice, similar to wild-type animals. In contrast, mice depleted of neutrophils alone or neutrophils and CD4(+) T cells developed clinical and pathological evidence of pulmonary aspergillosis and increased mortality (P < 0·05 compared to non-depleted animals). Our findings that T cells in CGD have a robust aspergillus CD4(+) T cell response suggest that CD4(+) T cell-based immunotherapy for this disease is unlikely to be beneficial.

Differential effects of volatile and intravenous anesthetics on the activity of human TASK-1.

Volatile anesthetics have been shown to activate various two-pore (2P) domain K(+) (K(2P)) channels such as TASK-1 and TREK-1 (TWIK-related acid-sensitive K(+) channel), and mice deficient in these channels are resistant to halothane-induced anesthesia. Here, we investigated whether K(2P) channels were also potentially important targets of intravenous anesthetics. Whole cell patch-clamp techniques were used to determine the effects of the commonly used intravenous anesthetics etomidate and propofol on the acid-sensitive K(+) current in rat ventricular myocytes (which strongly express TASK-1) and selected human K(2P) channels expressed in Xenopus laevis oocytes. In myocytes, etomidate decreased both inward rectifier K(+) (K(ir)) current (I(K1)) and acid-sensitive outward K(+) current at positive potentials, suggesting that this drug may inhibit TASK channels. Indeed, in addition to inhibiting guinea pig Kir2.1 expressed in oocytes, etomidate inhibited human TASK-1 (and TASK-3) in a concentration-dependent fashion. Propofol had no effect on human TASK-1 (or TASK-3) expressed in oocytes. Moreover, we showed that, similar to the known effect of halothane, sevoflurane and the purified R-(-)- and S-(+)-enantiomers of isoflurane, without stereoselectivity, activated human TASK-1. We conclude that intravenous and volatile anesthetics have dissimilar effects on K(2P) channels. Human TASK-1 (and TASK-3) are insensitive to propofol but are inhibited by supraclinical concentrations of etomidate. In contrast, stimulatory effects of sevoflurane and enantiomeric isoflurane on human TASK-1 can be observed at clinically relevant concentrations.

Extracellular Ca2+ is obligatory for ouabain-induced potentiation of cardiac basal energy expenditure.

1. The method of action of cardiac glycosides is commonly explained by the 'pump-inhibition hypothesis': inhibition of the Na+/K+-ATPase allows [Na+]i to rise, eventually reversing Na+/Ca2+ exchange. The resulting influx of Ca2+o increases [Ca2+]i, thereby activating intracellular Ca2+-dependent ATPases and, hence, energy demand. This sequence has been presumed to occur during diastole as well as systole. However, it has been reported that dihydro-ouabain-induced potentiation of heat production by quiescent ventricular trabeculae persists in the absence of Ca2+o. This implies that the pump-inhibition hypothesis is inapplicable during diastole. 2. We tested this implication by: (i). measuring the rate of oxygen consumption (Vo2) of arrested guinea-pig whole-hearts; (ii). measuring[Ca2+]i in quiescent ventricular trabeculae; and (iii). mathematical modelling using software (Oxsoft Heart, Oxford Software, Oxford, UK) based on DiFrancesco-Noble formalism. 3. Upon induction of arrest, whole heart Vo2 fell to one-quarter of its 'beating' value. Subsequent perfusion with ouabain (20 micromol/L), in the presence of Ca2+o, increased Vo2 fourfold. This increase was prevented by withholding Ca2+o. Comparable results were obtained in quiescent trabeculae: ouabain increased [Ca2+]i only if Ca2+o was present. Mathematical modelling readily simulated these experimental results. 4. We conclude that influx of Ca2+o is mandatory for potentiation of cardiac basal metabolism by cardiac glycosides.

Long-chain acyl-coenzyme A esters and fatty acids directly link metabolism to K(ATP) channels in the heart.

ATP-sensitive K (K(ATP)) channels are inhibited by cytosolic ATP, a defining property that implicitly links these channels to cellular metabolism. Here we report a direct link between fatty acid metabolism and K(ATP) channels in cardiac muscle cells. Long-chain (LC) acyl-coenzyme A (CoA) esters are synthesized from fatty acids and serve as the principal metabolic substrates of the heart. We have studied the effects of LC acyl-CoA esters and LC fatty acids on K(ATP) channels of isolated guinea pig ventricular myocytes and compared them with the effects of phosphatidylinositol 4,5-bisphosphate (PIP(2)). Application of oleoyl-CoA (0.2 or 1 micromol/L), a naturally occurring acyl-CoA ester, to the cytosolic side of excised patches completely prevented rundown of K(ATP) channels, but not of Kir2 channels. The open probability of K(ATP) channels measured in the presence of oleoyl-CoA or PIP(2) was voltage dependent, increasing with depolarization. Oleoyl-CoA greatly reduced the ATP sensitivity of K(ATP) channels. At a concentration of 2 micromol/L, oleoyl-CoA increased the half-maximal inhibitory concentration of ATP >200-fold. The time course of the decrease in ATP sensitivity was much faster during application of oleoyl-CoA than during application of PIP(2). The effects of PIP(2), but not of oleoyl-CoA, were inhibited by increasing Ca(2+) to 1 mmol/L. Oleate (C18:1; 10 micromol/L), the precursor of oleoyl-CoA, inhibited K(ATP) channels activated by oleoyl-COA: Palmitoleoyl-CoA and palmitoleate (C16:1) exerted similar reciprocal effects. These findings indicate that LC fatty acids and their CoA-linked derivatives may be key physiological modulators of K(ATP) channel activity in the heart.

Metabolic consequences of a species difference in Gibbs free energy of Na+/Ca2+ exchange: rat versus guinea pig.

The Gibbs free energy of the sarcolemmal Na+/Ca2+ exchanger (DeltaG(Na/Ca)) determines its net Ca2+ flux. We tested the hypothesis that a difference of diastolic DeltaG(Na/Ca) exists between rat and guinea pig myocardium. We measured the suprabasal rate of oxygen consumption (VO2) of arrested Langendorff-perfused hearts of both species, manipulating DeltaG(Na/Ca) by reduction of extracellular Na+ concentration, [Na+](o). Hill equations fitted to the resulting VO2-[Na+](o) relationships yielded Michaelis constant (K(m)) values of 67 and 25 mM for rat and guinea pig, respectively. We developed and tested a simple thermodynamic model that attributes this difference of K(m) values to a 7.84 kJ/mol difference of DeltaG(Na/Ca). The model predicts that reversal of Na+/Ca2+ exchange, leading to diastolic Ca2+ influx, should occur at a value of [Na+](o) about three times higher in rat myocardium. We verified this quantitative prediction using fura 2 fluorescence to index intracellular Ca2+ concentration in isolated ventricular trabeculae at 37 degrees C. The postulated difference in free energy of Na+/Ca2+ exchange explains a number of reported disparities of Ca2+ handling at rest between rat and guinea pig myocardia.

3-Dimensional configuration of perimysial collagen fibres in rat cardiac muscle at resting and extended sarcomere lengths.

1. We have used fluorescence confocal laser scanning microscopy to attain the three-dimensional (3-D) microstructure of perimysial collagen fibres over the range of sarcomere lengths (1.9-2.3 micrometers) in which passive force of cardiac muscle increases steeply. 2. A uniaxial muscle preparation (right ventricular trabecula of rat) was used so that the 3-D collagen configuration could be readily related to sarcomere length. Transmission electron microscopy showed that these preparations were structurally homologous to ventricular wall muscle. 3. Trabeculae were mounted on the stage of an inverted microscope and fixed at various sarcomere lengths. After a trabecula was stained with the fluorophore Sirius Red F3BA and embedded in resin, sequential optical sectioning enabled 3-D reconstruction of its perimysial collagen fibres. The area fraction of these fibres, determined from the cross-sections of seven trabeculae, was 10.5 +/- 3.9 % (means +/- s.d.). 4. The reconstructed 3-D images show that perimysial collagen fibres are wavy (as distinct from coiled) cords which straighten considerably as the sarcomere length is increased from 1.85 +/- 0.06 micrometer (near-resting length) to 2.3 +/- 0.04 micrometer (means +/- s.d., n = 4). These observations are consistent with the notion that the straightening of these fibres is responsible for limiting extension of the cardiac sarcomere to a length of approximately 2.3 micrometers.

Mechanisms of force inhibition by halothane and isoflurane in intact rat cardiac muscle.

1. We investigated the mechanisms underlying the negative inotropic effect of the volatile anaesthetics halothane and isoflurane using twenty-two intact, right ventricular trabeculae of rat. [Ca2+]1 was measured qualitatively using either fluo-3 or fura-2, loaded into the cytosol via the acetoxymethyl (AM) ester form. Diastolic sarcomere length was adjusted to 2.1-2.2 micrograms and experiments were performed at 21-23 degrees C. 2. Halothane (0.25-3%) and isoflurane (0.48-4%) produced dose-dependent decreases in the amplitudes of the intracellular Ca2+ transients and twitch force. When the fluorescent Ca2+ indicator signals were corrected for changes in autofluorescence, neither volatile anaesthetic significantly changed diastolic [Ca2+]. 3. The ability of halothane and isoflurane to induce Ca2+ release from the sarcoplasmic reticulum of quiescent trabeculae was examined. When the superfusate was Ca2+ ad Na+ free (thereby preventing Na(+)-Ca2+ exchange and Ca2+ influx), 2% halothane, but not 4% isoflurane, evoked a transient increase in [Ca2+]i. 4. Halothane and isoflurane produced reversible, dose-dependent changes in cellular autofluorescence, the pattern of which was consistent with an increase in concentration of the reduced forms of nicotinamide adenine nucleotides and flavoproteins. This observation supports the putative inhibitory action of volatile anaesthetics at the site of Complex I of the mitochondrial electron transport chain. 5. Addition of the fatty acid hexanoate, a substrate that can be metabolized in the face of Complex I inhibition, did not appreciably attenuate the anaesthetic-induced negative inotropy; however, it greatly diminished autofluorescence changes. 6. To determine whether direct actions of the volatile anaesthetics on the contractile system contributed to the negative inotropy, external [Ca2+] was varied to modulate the amplitude of the Ca2+ transient. In the presence of 2% halothane or 4% isoflurane, restoration of the peak Ca2+ transient to control levels did not restore peak force. Moreover, halothane (1%) and isoflurane (16%) each reduced maximal Ca2(+)-activated force (attained using ryanodine tetani and a high external [Ca2+]) by around 15%. 7. We conclude that the negative inotropic actions of halothane and isoflurane on intact cardiac muscle reflect both reduced availability of Ca2+ and decreased responsiveness of the contractile system to Ca2+. The inhibitory action of the volatile anaesthetics on mitochondrial function does not contribute significantly to the negative inotropy but may lead to changes in cellular autofluorescence and misinterpretation of fluorescent Ca2+ indicator signals.

Energetic effects of caffeine in face of retarded Na+/Ca2+ exchange in isolated, arrested guinea pig hearts.

The effects of caffeine, a widely used pharmacological tool for releasing Ca2+ from the sarcoplasmic reticulum (SR), on the resting rate of oxygen consumption and left ventricular diastolic pressure development of isolated, KCl-arrested, guinea pig hearts was examined. Caffeine (10 mmol/l) had no effect on either the rate of oxygen consumption or left ventricular pressure development. However, when Ca2+ extrusion via the Na+/Ca2+ exchanger was retarded, whether by reducing the external Na+ concentration ([Na+]o) from 143 to 57 mmol/l or through further depolarizing the membrane by increasing external K+ concentration ([K+]o) from 20 to 40 mmol/l, the subsequent introduction of caffeine evoked a pronounced increase in the rate of oxygen consumption. This was accompanied by a small contracture in the low [Na+]o condition only. In the absence of external Ca2+ the stimulatory effects of caffeine on cardiac energetics in either the low [Na+]o or 40 mmol/l [K+]o condition was totally prevented. It is concluded that Na+/Ca2+ exchange plays a major role in dictating the energetic response of the cardiac cell to pharmacological activation of the SR Ca2+ release channel by caffeine.

Effect of hyperosmotic perfusion on rate of oxygen consumption of isolated guinea pig and rat hearts during cardioplegia.

OBJECTIVE: The aim was to determine the metabolic consequence of increasing the osmolality of a crystalloid cardioplegic solution during periods of cardiac arrest. METHODS: Isolated hearts of guinea pig and rat were Langendorff perfused with Krebs-Henseleit solution at 37 degrees C and arrested by an increase in KCl. The rate of oxygen consumption was measured under standard isosmotic conditions and with the osmolality of the perfusate increased by addition of sucrose. RESULTS: Increased osmolality stimulated the rate of myocardial oxygen consumption in a dose dependent manner. At optimal dose (about twice normal osmolality), the oxygen consumption of the arrested heart approximated that of the beating, non-working heart measured prior to arrest. Potentiation of cardiac resting metabolism was greater in the rat than in the guinea pig, whether expressed in absolute terms or relative to the metabolism of the beating heart. Metabolic potentiation was accompanied by an increase of passive or diastolic left ventricular pressure in the rat but not in the guinea pig. The metabolic response was unaffected by coronary vasodilation (adenosine) and by inhibition of Ca2+ channels (verapamil); it was moderately diminished by perfusion with Ca(2+)-free solution. Procaine inhibited the hyperosomotic potentiation of oxygen consumption in a dose dependent manner. CONCLUSIONS: From the absence of passive force development in the guinea pig heart, it appears that the hyperosmotic stimulation of cardiac resting metabolism primarily reflects increased activity of the sarcoplasmic reticular Ca(2+)-ATPase subsequent to release of Ca2+ through a procaine inhibitable channel. Blunting of both the metabolic and mechanical responses in the guinea pig vis-a-vis the rat heart is attributed to the greater capability of the former to buffer myoplasmic Ca2+ via the energetically neutral Na(+)-Ca2+ exchange mechanism.

Nosocomial herpes simplex virus infection associated with oral endotracheal intubation.

BACKGROUND: To determine by culture the frequency of herpes simplex virus reactivation complicating oral endotracheal intubation. Additionally, clinical appearance and recognition of patient infection by attendant health care workers were studied. Last, evidence of any occupational acquisition of herpes simplex virus infection was sought. METHODS: In a prospective, non-randomized study, three serial viral cultures were taken of oro-facial or mucosal sites on the day of oral endotracheal intubation and in the subsequent 3rd and 5th or 7th days from 51 consecutive adults undergoing oral endotracheal intubation in a suburban community hospital. Clinical variables including appearances of lesions and therapeutic interventions were noted during serial assessments by study authors. Employee health records were reviewed for evidence of health care worker occupational herpes simplex virus infection associated with these cases. RESULTS: Of 51 patients, 4 were culture positive on the day of oral endotracheal intubation. Of the remaining 47 patients, serial cultures during the first week post intubation revealed herpes simplex virus in 25 (53.2%) patients. Of cohort variables studied, a history of prior oral herpes simplex virus was significantly associated with a subsequent positive viral culture for herpes simplex virus (relative risk, 2.29; 95% confidence interval, 1.48 to 3.56). Typical or atypical lesions were visible in only 52% of the herpes simplex virus culture-positive cases. No occupational transmission of herpes simplex virus was detected. Tape-securing practices appeared to contribute to the morbidity of herpes simplex virus eruptions. CONCLUSIONS: Nosocomial reactivation of herpes simplex virus infection complicated oral endotracheal intubation in our patient population in approximately one half of the patients who were intubated for more than 48 hours during the first week after the procedure. Clinically, the infection was recognizable in only one half of the virus culture-positive cases. Increased awareness of this infection is needed by health care workers, patients, and families. More information is needed on optimal therapy and prevention.

Hagfish humoral defense protein exhibits structural and functional homology with mammalian complement components.

A genomic clone and cDNA fragment encoding a portion of a humoral recognition molecule from the hagfish were isolated and sequenced. The serum protein has previously been described as having structural features that are immunoglobulin-like. Amino acid sequence obtained from the 77-kDa H1 heavy chain facilitated the isolation of a genomic clone containing at least two coding regions. Through use of primers derived from the genomic sequences, a 231-base-pair cDNA fragment was obtained by PCR from liver RNA. Comparison of the deduced 120-amino acid sequence from the N terminus of H1 with known protein sequences revealed substantial sequence similarity with the beta chain of the murine fourth complement component C4 and with the related third and fifth complement molecules C5 and C3 and the major histocompatibility complex-encoded sex-limited protein. Observation of structural and functional similarities associated with the sequence similarity indicate that these molecules share an evolutionary relationship: the polypeptide chain structure of hagfish complement-like protein (CLP) resembles that of C4; CLP contains a hidden thioester group on the 70-kDa chain; CLP binds to streptococcal cells and enhances the phagocytosis of yeast by hagfish leukocytes. These data suggest that CLP forms part of a non-clonally-derived complement-related humoral defense system in the hagfish.

Distinct Ig H chains in a primitive vertebrate, Eptatretus stouti.

Serum Ig from the Pacific hagfish, Eptatretus stouti, was isolated by affinity chromatography using a specific mAb (H.45). Analysis of the approximately 210-kDa molecule by SDS-PAGE under reducing conditions revealed two H chains of approximately 77 kDa (H1) and approximately 70 kDa (H2) and L chains of approximately 30 kDa. H1 and H2 were shown to differ with respect to their peptide maps, amino-terminal amino acid sequences, and reactivity to the mAb H.45, suggesting that they represent discrete H chain isotypes. Two-dimensional nonreducing/reducing SDS-PAGE demonstrated that H and L chains were covalently linked predominantly as H-H-L and H-L configurations. Noncovalently bound L chains were also found. H-H-L complexes were shown to contain H1-H2 heterodimers of H chains in addition to H1-H1 homodimers.

Breakdown and quantitation of the forked termination of replication intermediate of Bacillus subtilis.

Using a procedure that minimizes shear forces, the BamHI-derived forked termination of replication intermediate of Bacillus subtilis, called band I DNA, can be extracted with little or no accompanying band II DNA. It has been shown that band II DNA is a product of band I breakdown. Nuclease P1-mediated breakdown of the forked band I DNA proceeds in two steps. The first causes the release of one of the arms as band II DNA; in the second step, the remaining arm is cleaved away to yield the free stem. It is concluded that band I represents the primary termination of replication intermediate. A quantitative assessment of the level of band I in DNA from cells of the merodiploid strain, GSY1127, growing at different rates has been made. For cells grown in a minimal medium, at least, the experimentally measured level of band I is of the order (approx. 60%) of that predicted for a complete block to movement of the clockwise fork at the replication terminus, terC.