Demonstration of a specific receptor for human C5a anaphylatoxin on murine macrophages.

Human C5a anaphylatoxin is known to be a potent mediator of the acute inflammatory response. It serves to trigger a wide variety of neutrophil responses after binding to a specific cellular receptor. We have now demonstrated that this bioactive glycopolypeptide is also bound to a specific receptor found on murine resident peritoneal macrophages, thioglycollate-induced exudate macrophages, and the murine cell line P388D1. The apparent Kd of the C5a receptors. Resident macrophages appear to have an average of 2 x 10(5) binding sites per cell, whereas thioglycollate- induced cells have only 4-5 x 10(4) binding sites. The continuous cell line P388D1 is intermediate between these two cell types, exhibiting 8-10 x 10(4) C5a receptors per cell. Neither murine lymphocytes nor the parent cell line P388 displays a measurable number of C5a receptors. Macrophage receptor-C5a binding interactions are followed by cellular uptake and degradation of 125I-C5a, much as is observed with neutrophils. As demonstrated in another paper, binding of C5a to macrophages results in augmentation of the primary humoral immune response as well as enhancement of mixed lymphocyte reactions. These observations suggest that C5a should not only be considered as an acute inflammatory mediator but as an immunopotentiating modulator as well, thus serving as a critical link between complement activation and subsequent immune responses.

Induction of interleukin 1 secretion and enhancement of humoral immunity by binding of human C5a to macrophage surface C5a receptors.

The mechanism by which human C5a anaphylatoxin augments the primary humoral response of murine splenocytes to antigen has been investigated. Culture supernatants were generated from splenic adherent cells or macrophage cell lines after exposure to a brief pulse of human C5a. Supernatants from the macrophage-like cell line P388D1, which bears surface receptors for C5a, enhance the PFC response to antigen, whereas those from the closely related cell line P388, which lacks surface receptors for C5a, fail to cause enhancement. Supernatants from splenic adherent cells, which also bear C5a receptors, similarly augment the SRBC response. Active supernatants, but not those devoid of activity, were shown to contain interleukin 1 (IL-1) activity by both the thymocyte mitogenesis and thymocyte costimulator assays. None of the supernatants contained IL-2 activity. These observations suggest that the recently described role of human C5a as an immunopotentiating modulator is mediated by its ability to induce production of IL-1 upon binding to specific receptors at the macrophage cell surface.

Attachment of human C5a des Arg to its cochemotaxin is required for maximum expression of chemotactic activity.

The chemotactic activity of human C5a des Arg is enhanced significantly by an anionic polypeptide (cochemotaxin) in normal human serum and plasma. We have found that the cochemotaxin attaches to the oligosaccharide chain of native C5a des Arg to form a complex with potent chemotactic activity for human polymorphonuclear leukocytes. Although capable of enhancing the chemotactic activity of native C5a des Arg, the cochemotaxin had no effect on the chemotactic activity of either deglycosylated C5a des Arg, native C5a, or N-formyl-methionyl-leucyl-phenylalanine. Of the known components of the oligosaccharide chain, only sialic acid prevented enhancement by the cochemotaxin of the chemotactic activity exhibited by native C5a des Arg. Sialic acid also prevented the formation of C5a des Arg-cochemotaxin complexes, detected by acid polyacrylamide gel electrophoresis, molecular sieve chromatography on polyacrylamide gels, and sucrose density gradient ultracentrifugation.

C5a and formyl peptide receptor regulation on human monocytes.

Regulation of C5a and formyl-methionine-leucine-phenylalanine-lysine (fMLPL) receptors on human monocytes has been studied using fluorescein-conjugated derivatives and flow cytometry. Monocytes have receptors for each of these ligands, as evidenced by their ability to bind specifically biologically active fluorescein derivatives of these ligands. Quenching experiments showed that bound fluoresceinated C5a and fMLPL are rapidly internalized at 37 degrees C. Once internalized, monocytes are able to reexpress these receptors, returning to control levels within approximately 90 min. This contrasts with rate differences seen in polymorphonuclear neutrophils (PMNs), where fMLPL receptors return more rapidly (approximately 30 min) than do C5a receptors (approximately 100 min). Monensin inhibited the reexpression of C5a but not fMLPL receptors, suggesting that a receptor recycling process is necessary to replenish C5a receptors on the monocyte surface. Similar although less efficient inhibition of C5a receptor reexpression was observed with NH4Cl treatment. Reexpression of both C5a and fMLPL receptors was independent of extracellular Ca2+. Treatment with various agents known to stimulate monocytes and PMNs increased the expression of fMLPL receptors in both cell types but either had no effect on or reduced the level of C5a receptor expression. This would indicate that monocytes, like PMNs, have intracellular pools of preformed fMLPL receptors, available for reexpression. These studies show that, like PMNs, monocytes modulate C5a and fMLPL receptors through different mechanisms. Furthermore, monocytes are capable of reexpressing these receptors following exposure to ligand, a theoretical requirement for chemotaxis.

Relationship of chemotactic receptors for formyl peptide and C5a to CR1, CR3, and Fc receptors on human neutrophils.

The co-expression of C5a and formyl-methionine-leucine-phenylalanine-lysine (FMLPL) receptors with CR1, CR3, and Fc receptors on human neutrophils (PMN) was studied. Fluorescein-conjugated C5a (FL-C5a) and FMLPL (FL-FMLPL) were used to identify C5a and formyl peptide receptors. CR1, CR3, and Fc receptors were identified with monoclonal antibodies and a Texas red-labeled goat anti-mouse immunoglobulin second step reagent. The co-expression of chemotactic receptors with CR1, CR3, or Fc receptors was evaluated using two-color flow cytometry. A direct correlation between the degree of expression of receptors for FL-FMLPL and the expression of CR3, CR1, and Fc receptors on individual PMN was observed. In contrast, no correlation between the degree of C5a receptor expression and CR1, CR3, or Fc receptor expression was found. Similar results were obtained with PMN after up regulation of CR1, CR3, Fc, and FMLPL receptors by incubation at 37 degrees C for 10 min with or without phorbol myristate acetate. These data suggest that the expression of FMLPL, CR1, CR3, and Fc receptors are regulated in a similar manner, whereas C5a receptor expression is regulated independently. Furthermore, these data indicate that within a given population of PMN, a parallel exists between the degree of CR1, CR3, FMLPL, and Fc receptor expression on individual cells.

Wheat germ agglutinin inhibits the C5a receptor interaction: implications for receptor microheterogeneity and ligand binding site.

Wheat germ agglutinin (WGA) has been shown to inhibit the interaction of C5a with the C5a receptor on both polymorphonuclear neutrophils (PMNs) and the histiocytic cell line U937. The level of inhibition with isolated receptor preparations is 100%, and on intact cells 10 to 20% of the receptor population appear to retain their ability to bind C5a in the presence of WGA. In contrast, this lectin completely inhibits the C5a-mediated degranulation of PMN primary and secondary granules, suggesting that the population of C5a receptors responsible for mediating degranulation is also recognized by WGA. More than 50% of the receptors appear to be blocked before an effect on degranulation occurs. This inhibition by WGA does not appear to be due to down-regulation of C5a receptors from the cell surface, excessive aggregation of receptor sites, or interaction of WGA with the carbohydrate portion of the C5a molecule. The inhibition is reversed by N-acetylglucosamine but not by sialic acid. This effect appears to be specific for WGA because various other lectins do not inhibit the C5a receptor interaction. That the inhibition by WGA is due to direct binding of the lectin to N-acetylglucosamine residues on the C5a receptor is strongly supported by the ability of the cross-linked C5a-receptor complex to bind to and be specifically eluted from a WGA-Affigel affinity matrix. These observations are consistent with hypothesis that the population of C5a receptors on leukocytes exhibits microheterogeneity with respect to structure (carbohydrate content) and/or function.

Modulation of neutrophil-reduced pyridine nucleotide content following stimulation with phorbol myristate acetate and chemotactic factors.

Modulation of NAD(P)H in human neutrophils (PMN) following stimulation with phorbol myristate acetate (PMA) or chemotactic factors was determined by flow cytometry. Stimulation of PMN with 1 microgram/ml of PMA results in a time-dependent decrease in fluorescence, attributable to the oxidation of NAD(P)H. The decrease in fluorescence did not occur with PMN from a patient with chronic granulomatous disease (CGD) and was observed in only half of PMN from the mother of the patient. Loss of fluorescence in normal PMN was maximal following 7-15 min of stimulation with PMA. Simultaneous measurement of PMA-stimulated NAD(P)H oxidation and H2O2 production showed that NAD(P)H oxidation occurred as an all-or-none response while H2O2 production showed a graded response. These data suggest that with PMA stimulation, a threshold exists beyond which constitutive NAD(P)+ reduction is suppressed and complete oxidation of NAD(P)H occurs, while H2O2 production is proportional to the concentration of PMA. PMA-stimulated oxidation of NAD(P)H was reversible, and fluorescence returned to the initial level or higher after 40-60 min. Oxidation of NAD(P)H also occurred when cytochalasin B-treated PMN were stimulated with 25 nM C5a or 100 nM formyl-methionyl-leucyl-phenylalanine (f-MLP), but occurred more rapidly, peaking at 1 to 3 min. Fluorescence also returned by 5-6 min. This response to C5a and f-MLP was graded and proportional to the concentration of chemotactic factor used. Comparative studies showed that the cytochalasin-B treatment was essential for measurement of NAD(P)H oxidation, in response to C5a and F-MLP.

Complement and the damaging effects of cardiopulmonary bypass.

Postoperative cardiac, pulmonary, renal and coagulation dysfunction, along with C3a levels, were studied prospectively in 116 consecutive patients undergoing open cardiac operations and 12 patients undergoing closed operations in the same time period. The level of C3a 3 hours after open operation was high (median value 882 ng X ml-1 plasma) and was related to the C3a level before cardiopulmonary bypass (CPB) (p = 0.03), the level at the end of CPB (p less than 0.0001), elapsed time of CPB (p = 0.07), and older age at operation (p less than 0.0001). It was inversely related to the cardiac output as reflected by the strength of the pedal pulses (p = 0.006). In contrast, C3a levels did not rise in patients undergoing closed operations. The probability of postoperative cardiac dysfunction after open operations (present in 27 of 116 patients) was predicted by C3a levels 3 hours after operation (p = 0.02), the CPB time (p = 0.02), and younger age (p less than 0.0001). The same risk factors pertained for postoperative pulmonary dysfunction (present in 41 of the 116 patients); renal dysfunction (present in 24 of the 116 patients) except that CPB time was not a risk factor here; abnormal bleeding (present in 21 of the 116 patients); and important overall morbidity (present in 26 of 116 patients). As regards important overall morbidity, the C3a level effect became evident at about 1,900 ng X ml-1 (a level reached by 9% of patients); the effect of increasing time of CPB became evident at about 90 minutes of CPB time; and the effect of young age became evident as age decreased from 10 to 4 years. This study demonstrates the damaging effects of CPB, relates them in part to complement activation by the foreign surfaces encountered by the blood, and supports the hypothesis that the mechanisms of the damaging effects include a whole-body inflammatory reaction.

Complement activation in extracorporeal circuits.

Clinical studies performed with various types of hemodialyzers provide a data base and conceptual framework for understanding blood-material interactions that result in complement activation. Current findings suggest that the complement-activating potential of biomaterials may be defined by quantitating either fluid-phase C3a antigen or measurement of surface-bound C3 fragments. Furthermore, systematic studies can reveal material properties that regulate both the production and distribution of the human anaphylatoxins. Assessing the fate of the C5a anaphylatoxin is particularly important because it is likely that generation of this bioactive molecule in extracorporeal circuits initially triggers granulocyte responses and may produce cardiopulmonary manifestations if the C5a is formed in sufficient quantities. It seems likely that detailed knowledge of these varied phenomena will permit rational design of newer "biocompatible" materials and membranes.

Escherichia coli and human neutrophils. Effect of bacterial supernatant with hemolysin activity upon chemotaxin receptors.

A greater proportion of Escherichia coli strains isolated from clinical extraintestinal infections produce alpha-hemolysin than do strains isolated from normal fecal flora. Proposed mechanisms to explain this observation have stressed the fact that hemolysis liberates hemoglobin, which may provide a nutritional boost for E coli growth. Alternatively, a cytolytic effect of hemolysin upon host neutrophils has been postulated. Our previous studies have suggested a third possibility: Human neutrophils incubated in the supernatant of an alpha-hemolysin-producing E coli strain produced a selective inhibition of chemotaxis toward C5a. Bacteria-free supernatants from 14 clinical strains of E coli were therefore evaluated for an ability to lyse sheep erythrocytes, alter human polymorphonuclear neutrophil (PMN) chemotaxin receptors, and affect release of PMN enzymes. Supernatants possessing hemolytic activity decreased the C5a receptor activity of human PMNs and increased the number of peptide receptors. A stimulation of secondary granule release, as evidenced by the release of PMN lysozyme, may account for the increased expression of peptide receptors. Perturbation of host defenses through a loss of neutrophil migratory function and secondary granule contents may allow for enhanced survival of E coli, which produce alpha-hemolysin.

Effects of protamine administration after cardiopulmonary bypass on complement, blood elements, and the hemodynamic state.

Nineteen patients were prospectively selected and studied before and after the administration of protamine sulfate following cardiopulmonary bypass (CPB). After protamine administration, C3a, C4a, and C4d were elevated; the peak levels of C3a and C4a were in samples taken 10 minutes after protamine administration while those of C4d were in those obtained at 5 hours. Only C3a was elevated after CPB and before protamine administration. In vitro, only the combination of protamine sulfate and heparin, and neither alone, resulted in increased C3a and C4a. Administration of protamine was associated with small and transient decreases in total white blood cells, granulocytes, and platelets, and with small and transient reductions in systemic and pulmonary arterial and left and right atrial pressures. Systemic vascular resistance fell (p = 0.07), and pulmonary vascular resistance rose but the change could be due to chance (p = 0.29). These data and those reported by others support the inference that complement activation occurs during CPB by the alternative pathway and again during protamine administration by the classic pathway; and that this accompanies a whole-body inflammatory reaction with blood cell and hemodynamic changes which, when extreme, could result in a severe hemodynamic derangement.

Alterations in chemotactic factor-induced responses of neutrophils and monocytes from chronic dialysis patients.

Chronic renal failure patients on dialysis have an increased susceptibility to infection. Previous studies have demonstrated that these patients have a decreased in vitro neutrophil (PMN) chemotactic response and a reduction in C5a receptor availability on both PMN and monocytes. This study was designed to determine if other chemotactic factor-mediated responses of PMN and monocytes from hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients are abnormal. The responses investigated included in vitro chemotaxis, superoxide generation, H2O2 production, and myeloperoxidase (MPO) release. These studies showed that PMN from HD and CAPD patients are significantly decreased in their chemotactic response to both C5a and fMLP when compared to normal controls. The response of HD patient's PMN to C5a was decreased by an average of 55.1% (p less than 0.005) and for CAPD patients by 49.7% (p less than 0.01). Similarly, chemotactic responses to fMLP were decreased by an average of 44.7% (p less than 0.005) for HD patients and 36.3% (p less than 0.02) for CAPD patients. Superoxide anion production by PMN and monocytes from HD and CAPD patients in response to C5a and fMLP was also significantly decreased compared to controls. PMN superoxide production in response to C5a was decreased by an average of 36.5% (p less than 0.001) for HD patients and 32.0% (p less than 0.001) for CAPD patients. fMLP-stimulated production of superoxide was also decreased but to a lesser degree with a mean decrease of 18.0% (p less than 0.01) for HD patients and 24.1% decrease (p less than 0.01) for CAPD patients. This decreased responsiveness was restricted to C5a- and fMLP-stimulated superoxide production since phorbol myristate acetate (PMA)-stimulated responses were comparable to controls. A similar pattern of decreased superoxide production was found with monocytes from these patients. Comparable decreases in chemotactic factor-stimulated responses were also observed in a flow cytometric assay of H2O2 production in both PMN and monocytes and an in vitro assay of MPO release from PMN. Analysis of the binding of fluorescent C5a to PMN showed a direct correlation between decreased C5a binding and decreased O2- production and MPO release. Since all of these chemotactic factor-stimulated events are involved in the inflammatory process and the killing of microorganisms, alterations in these WBC functions in dialysis patients may contribute to their increased susceptibility to infection.

C5a receptor modulation on neutrophils and monocytes from chronic hemodialysis and peritoneal dialysis patients.

Chronic renal failure patients have an increased risk for infection which may partially be due to altered chemotactic ability of their white blood cells. This study was designed to evaluate chemotactic factor and Fc receptor expression on neutrophils (PMN) and monocytes from chronic renal failure patients on hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD). Analysis of these receptors was performed using flow cytometry and fluorescent chemotactic factors (C5a, f-Met-Leu-Phe-Lys [fMLPL] and casein) and heat-aggregated human IgG. Peripheral blood PMN and monocytes obtained from 14 HD patients (in the predialysis period) and 14 CAPD patients were analyzed for their ability to bind each of the fluoresceinated ligands. PMN and monocytes from both patient groups had a significant reduction in their ability to bind C5a. The average percentage (+/- s.e.m.) of PMN that bound C5a was 93.9 +/- 1.1 for the controls, 72.9 +/- 3.8 for HD patients, and 79.3 +/- 4.0 for CAPD patients. Similar results were obtained with monocytes with 69.7 +/- 1.9% for controls, 54.6 +/- 4.5% for HD patients, and 31.0 +/- 4.5% for CAPD patients. These differences in C5a binding were also reflected in the average intensity of fluorescence. There was no significant difference in the percentage or fluorescence intensity of PMN or monocytes that bound casein or aggregated IgG when either group of dialysis patients was compared to the control values. Binding of fMLPL by PMN and monocytes from the HD patients and PMN from the CAPD patients were similar to control values but the binding of fMLPL by monocytes from CAPD patients was significantly suppressed (p less than 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

The properties of human C5a anaphylatoxin. The significance of C5a formation during hemodialysis.

Human C5a anaphylatoxin is a potent bioactive molecule that possesses both spasmogenic and leukocyte-related properties. As such, it normally serves as a local mediator of the acute inflammatory response. Additionally, C5a, through its actions of mononuclear phagocytes, may act to bridge the gap in the acute-chronic inflammatory continuum. While these properties are critical to normal host defense mechanisms, it is now apparent that this anaphylatoxin and/or its des-Arg74 derivative, may exert significant systemic effects that are manifest as cardiopulmonary abnormalities and intravascular activation of granulocytes. Knowledge of these properties is critically important for understanding the clinical sequelae exhibited by patients undergoing extracorporeal circulation since we now know that both hemodialysis and cardiopulmonary bypass [28-30] procedures promote intravascular complement activation and C5a formation. Viewed in this context, it seems reasonable to postulate that many of the immediate and delayed responses to extracorporeal circulation might be mediated by C5a formed in the extracorporeal circuit (table IV). For example, it is now recognized that a few particularly susceptible patients display adverse reactions during the initial phases of hemodialysis. The symptoms of this so-called 'first-use syndrome' may range from severe urticaria and angioedema to life-threatening bronchospasm, hypotension, and cardiopulmonary collapse. Some investigators have presented data which suggest that complement-derived products may be causative of these symptoms in some patients [31]. While this hypothesis remains to be confirmed, present evidence clearly demonstrates that C5a alone may produce many of the observed phenomena. In addition to the acute effects produced by C5a, both our own basic studies and the clinical investigations presented by others at this conference suggest that the long-term effects of repeated C5a exposure in the dialyzed patient may be considerable. Thus, there has been a great deal of interest in the role of complement-derived mediators as initiators of leukocyte degranulation and toxic oxygen radical production and an exploration of the significance of these events in the eventual development of chronic pulmonary fibrosis in the dialyzed patient. Similarly, the effects of repeated exposure to IL-1 that has been postulated to occur as a result of C5a triggering of monocytes during dialysis is currently an active area of investigation.(ABSTRACT TRUNCATED AT 400 WORDS)

Complement activation produced by biomaterials.

The complement-activating potential of biomaterials may be defined by appropriate application of C3a and C5a anaphylatoxin radioimmunoassays. Studies performed with hemodialysis membranes demonstrate that blood contact with these model biomaterials results in complement activation that may be ascribed to specific properties of the material surface. Further delineation of these chemical and physical properties may permit design of biocompatible materials.

Anaphylatoxin formation in extracorporeal circuits.

Anaphylatoxin radioimmunoassay techniques have been employed to define both the temporal profile and the amount of complement activation taking place in two different types of extracorporeal circuits. Prospective studies of patients undergoing both maintenance hemodialysis and cardiopulmonary bypass provided essentially similar findings. In both cases, plasma C3a antigen levels proved to be the most accurate and sensitive indicator of intravascular complement activation. By contrast, plasma C5a levels varied little during the period of extracorporeal circulation. Instead, this anaphylatoxin retained considerable biologic activity in vivo as evidenced by its ability to promote granulocyte activation and transient granulocytopenia which was displayed by patients in both groups. Plasma levels of C4a antigen were not elevated during the period of extracorporeal circulation, suggesting that alternative pathway mechanisms were predominantly responsible for the complement activation taking place in both hemodialyzers and bypass oxygenators. However, classical pathway activation events could be documented when protamine sulfate was administered to heparinized patients after cardiopulmonary bypass. In this instance, elevated plasma levels of both C4a and C3a antigens were observed. Prospective studies also suggested that complement activation could be associated with the development of both acute and delayed clinical sequelae. Available data support the hypothesis that C5a anaphylatoxin might be the primary mediator of these undesirable effects of extracorporeal circulation. These types of investigations have contributed significantly to our understanding of the role of the anaphylatoxins in human disease and may be directly applied to facilitate design of more biocompatible medical devices.

Complement activation during hemodialysis: clinical observations, proposed mechanisms, and theoretical implications.

Human C3a radioimmunoassay techniques were employed to define both the temporal profile and the amount of complement activation taking place in the extracorporeal circuit during maintenance hemodialysis. Prospective studies demonstrated that C3a formation, like hemodialysis-associated leukopenia, was a transient phenomenon that occurred predominantly during the first 30 min of dialysis. Quantitative comparisons revealed that new Cuprophan hemodialyzers displayed somewhat greater complement-activating potential than cellulose acetate dialyzers. By contrast to new Cuprophan membranes, both reused Cuprophan and polyacrylonitrile dialyzers exhibited only a modest ability to activate human complement. These findings are compatible with the known mechanisms of complement activation and suggest that certain chemical and biochemical methods might be exploited to enhance the biocompatibility of cellulose dialysis membranes.