[ROC curve-based evaluation of platelet parameters for predicting delayed renal graft function].

OBJECTIVE: To investigate the value of evaluating 5 platelet parameters in predicting delayed graft function (DGF) in patients following kidney transplantation. METHODS: We retrospectively analyzed the pre- and postoperative (within 2 months) data of 330 renal transplant recipients. The cases with DGF and those without were analyzed to assess the association between relationship between DGF following transplantation and the variations of blood platelet parameters including platelet count (PLT), large platelet ratio (P-LCR), mean platelet volume (MPV), platelet volume distribution width (PDW) and platelet hematocrit (PCT). RESULTS: The DGF and non-DGF cases were comparable for the platelet parameters before the operation. On postoperative day 7 when the diagnosis of DGF was made, PLT (P<0.05) and PCT (P<0.02) were significantly lower while MPV (P<0.01), PDW (P=0.036) and P-LCR (P=0.01) significantly higher in DGF group than in non-DGF group. The AUCs of P-LCR (0.611±0.047), PDW (0.603±0.048) and MPV (0.762±0.037) were significantly higher than the reference area (P<0.05) with cut-off values of 34.80%, 12.95fl and 11.55fl, respectively. MPV showed a high sensitivity, specificity and Youden index for predicting DFG; PDW and P-LCR had a high sensitivity but a low specificity for predicting DFG with a modest diagnostic value. PLT and PCT, with AUCs of were 0.37 and 0.38, respectively, did not have a predictive value for DGF. CONCLUSIONS: Significant variations in platelet parameters occur in the event of DGF in renal transplant recipients, and monitoring the postoperative changes in MPV, PDW, and P-LCR can help in early diagnosis and treatment of DGF. MPV has a moderate value (0.7-0.9) in predicting DGF, and a MPV>11.55 fl suggests the risk of DGF.

Panax notoginseng saponins mitigate ovariectomy-induced bone loss and inhibit marrow adiposity in rats.

OBJECTIVE: Previous data have suggested that Panax notoginseng saponins (PNS) can prevent estrogen deficiency-induced bone loss by dual action: stimulation of new bone formation and inhibition of bone resorption. Marrow adipogenesis has been identified as a negative indicator of skeletal strength and integrity. This study assessed the effects of early PNS supplementation on bone microarchitecture preservation and marrow fat content in an ovariectomized rat model. METHODS: Forty adult female Sprague-Dawley rats were randomly assigned to four equal groups for 12 weeks of treatment: (1) sham operation (SHAM) + vehicle; (2) ovariectomy (OVX) + vehicle; (3) OVX + 17ß-estradiol (25 µg/kg); (4) OVX + PNS (300 mg/kg/d, PO). Marrow fat content of the femur was determined, using fat/water magnetic resonance imaging (MRI), at baseline and 6 and 12 weeks after operation. At the end of the experiment, bone turnover, trabecular microarchitecture, and marrow adipocytes were assessed by serum biomarkers, micro-computed tomography (micro-CT), and histopathology, respectively. The effects of PNS on adipocytic differentiation were reflected by expression levels of the adipogenic genes PPARγ2 and C/EBPα, as determined by reverse transcription-polymerase chain reaction. RESULTS: Ovariectomized rats experienced remarkable increases in marrow fat content across time points, which were accompanied by elevated rate of bone turnover, global volumetric bone density, and trabecular microarchitecture deterioration. These OVX-induced pathological changes are reversible in that most of them could be mostly corrected upon 17ß-estradiol treatment. PNS treatment significantly reduced marrow adipogenesis (adipocyte density, -27.2%; size, -22.7%; adipocyte volume-to-tissue volume ratio, -53.3%; all P < 0.01) and adipocyte marker gene expression, and prevented bone mass loss and microarchitecture deterioration. Moreover, PNS enhanced osteoblast activity but suppressed osteoclast turnover, as evidenced by decreased levels of serum C-terminal telopeptides of type I collagen and elevated levels of alkaline phosphatase. CONCLUSIONS: PNS mitigates estrogen deficiency-induced deterioration of trabecular microarchitecture and suppresses marrow adipogenesis.

Tracheal gas insufflation with partial liquid ventilation to treat LPS-induced acute lung injury in juvenile piglets.

OBJECTIVES: Partial liquid ventilation (PLV) with perfluorocarbons (PFC) seems not superior to conventional ventilation clinically. We hypothesized that a combination of continuous tracheal gas insufflation (TGI) with protective strategy of PLV (low dose of PFC, low inflation pressure, moderate inhalation of oxygen and moderate anesthesia) would improve cardiopulmonary function in acute lung injury. METHODS: Twenty-four healthy juvenile piglets were anesthetized and mechanically ventilated at PEEP of 2 cmH(2)O with a peak inspiratory pressure of 10 cmH(2)O and FIO(2) of 0.4. The piglets were challenged with lipopolysaccharide and randomly assigned to four groups (n = 6 each): (1) mechanical ventilation alone (MV); (2) PLV with perfluorodecalin (10 ml/kg); (3) TGI with continuous airway flow 2 L/min; and (4) combination of PLV and TGI. The outcome was assessed functionally and histologically. RESULTS: All treatments except MV improved pH, PaO(2)/FIO(2), PaCO(2), ventilation efficacy index (VEI) and tidal volume. Both PLV-associated treatments also improved heart rate, respiratory rate, pulse contour cardiac output, systemic vascular resistance, dynamic lung compliance, mean airway resistance and mean airway pressure. The combination group resulted in higher PaO(2)/FIO(2), VEI and a better lung histology score than any other treatments. CONCLUSIONS: The new protective strategy may provide a better treatment for sepsis-induced acute lung injury.

Pulmonary innervation, inflammation and carcinogenesis.

Lung cancer is a major medical problem. Despite advances in molecular biology and pharmacology, the outcome of lung cancer treatment is unsatisfactory. Clinically, inflammation and cancer are closely associated, and, genetically, these two processes are regulated by the same gene loci. Inflammation promotes cancer formation. Increasing evidence shows that neuroimmune interaction involving inflammatory disease and the vagus nerves are crucial in the interaction. Airway sensory receptors are biosensors that detect the lung inflammatory process through various mediators and cytokines. This information is transmitted through vagal afferents to the brain and produces a host of responses that regulate the extent and intensity of inflammation. Tumor cells express receptors for neurotransmitters and provide a substrate for direct interaction with neurons. Thus, neural regulation of the immune response is targeted towards inflammation as well as tumors. The airway sensors can detect cancer-related cytokines, which provides a direct pathway to inform the brain of tumor growth. The knowledge of how these sensors may monitor tumor progression and provide neuroimmune interaction in the control of tumor development and metastasis will improve our treatment of lung cancer.

Continuous tracheal gas insufflation during protective mechanical ventilation in juvenile piglets with acute lung injury induced by endotoxin.

BACKGROUND: Low tidal volume mechanical ventilation is difficult to correct hypoxemia, and prolonged inhalation of pure oxygen can lead to oxygen poisoning. We suggest that continuous tracheal gas insufflation (TGI) during protective mechanical ventilation could improve cardiopulmonary function in acute lung injury. METHODS: Totally 12 healthy juvenile piglets were anesthetized and mechanically ventilated at PEEP of 2 cmH2O with a peak inspiratory pressure of 10 cmH2O. The piglets were challenged with lipopolysaccharide and randomly assigned into two groups (n=6 each group): mechanical ventilation (MV) alone and TGI with continuous airway flow 2 l/min. FIO2 was set at 0.4 to avoid oxygen toxicity and continuously monitored with an oxygen analyzer. RESULTS: Tidal volume, ventilation efficacy index and mean airway resistant pressure were significantly improved in the TGI group (P<0.01 or P<0.05). At 4 hours post ALI, pH decreased to below 7.20 in the MV group, and improved in the TGI group (P<0.01). Similarly, PaCO2 was stable and was significantly lower in the TGI group than in the MV group (P<0.01). PaO2 and PaO2/FIO2 increased also in the TGI group (P<0.05). There was no significant difference in heart rate, respiratory rate, mean artery pressure, central venous pressure, dynamic lung compliance and mean resistance of airway between the two groups. Lung histological examination showed reduced inflammation, reduced intra-alveolar and interstitial patchy hemorrhage, and homogenously expanded lungs in the TGI group. CONCLUSION: Continuous TGI during MV can significantly improve gas exchange and ventilation efficacy and may provide a better treatment for acute lung injury.

Partial liquid ventilation confers protection against acute lung injury induced by endotoxin in juvenile piglets.

To investigate the effect of partial liquid ventilation (PLV) at low inflation pressures on acute lung injury (ALI), endotoxin was administered to healthy anesthetized juvenile piglets. The animals were randomly assigned to two groups, n=6 each: (1) conventional mechanical ventilation (MV) and (2) PLV with perfluorodecalin (10 mL kg(-1)). Compared with MV, PLV improved each cardiopulmonary variable measured. These variables included pulse contour cardiac output, heart rate, blood pH, breathing rate, both partial pressure of arterial oxygen (PaO2) and PaO2/FIO2 (fraction of inspired oxygen), partial pressure of arterial carbon dioxide (PaCO2), dynamic lung compliance, tidal volume, and ventilation efficacy index. Lung morphology also showed less damage in the PLV group, even in non-dependent regions (P<0.05). Our data support the hypothesis that PLV can decrease pulmonary damage, improve gas exchange and cardiac output, and may lead to a better prognosis in endotoxin-induced ALI.

[Modulation of TLR9 on anti-tumor immune responses of peripheral blood mononuclear cells from patients with non-small-cell lung cancer].

OBJECTIVE: To assess the modulation of TLR9 on anti-tumor immune responses in peripheral blood mononuclear cells (PBMC) from patients with non-small-cell lung cancer (NSCLC). METHODS: PBMCs were isolated from 36 NSCLC patients. Lung cancer cells were isolated from these patients and further enriched. PBMCs were cultured in RPMI-1640 medium (blank control group), and medium with cytosine guanine oligodeoxynucleotide (CpG ODN, an TLR9 agonist) or control ODN for 72 h; and then flow cytometry was used to examine the expression of CD69 antigen on the surface of CD3 cells, [3H]-thymidine incorporation method was used to examine the cell proliferation, and the IFN-alpha level in the supernatant was measured. Another PBMCs were cultured in medium with interleukin (IL)-1 and then CpG ODN, control ODN, and CpG ODN + chloroquine or inhibitory ODN were added respectively for 24-48 h. Then the IFN-alpha in the supernatant was measured. Subsets were assessed by flow cytometry and the expression of TLR9-mRNA in freshly isolated PBMC was detected by RT-PCR. The production of interferon (IFN)-alpha in the PBMCs was measured by ELISA. The proliferation of the PBMCs was determined by [3H]-thymidine incorporation. The PBMCs co-cultured with CpG ODN and autologous lung tumor cells treated with mitomycin C were used as effector cells, and K562 cells and autologous tumor cells were used as target cells flow cytometry was used to detect the capacity of PBMCs to kill autologous lung tumor cells and K562 cells. Meanwhile we investigated the intracellular expression of IFN-gamma and IL-4 in CD8+ T. RESULTS: The expression level of TLR9 of the PBMCs from patients was not significantly different from that of the PBMCs from the healthy donors. The proportion of CD69 antigen expressing CD3+ T cells of the CpG ODN group was (39.5 +/- 8.9)%, significantly higher than those of the blank control group [(8.8 +/- 1.2)%, t = 40.30, P = 0.00] ands control ODN group [(10.6 +/- 1.0)%, t = 41.85, P = 0.00]. Examination with beta liquid scintillation counter showed that the cpm value of the CpG ODN group was (1.61 +/- 0.20) x 10(4), significantly higher than those of the blank control group [(0.27 +/- 0.14) x 10(4), t = 20.43, P = 0.00] and control ODN group [(0.34 +/- 0.13) x 10(4), t =20.20, P = 0.00]. Chloroquine and inhibitory ODN dose-dependently inhibited the IFN-alpha levels in the supernatant. The CD4 + T/CD8 + T of the CpG ODN group was (3.44 +/- 0.20), significantly higher than those of the control ODN group (1.73 +/- 0.27, t = 19.85, P = 0.00) and blank control group (1.69 +/- 0.13, t = 29.32, P = 0.00). The IFN-gamma positive CD8 + T cells of the CpG ODN group was (18.5 +/- 4.2)%, significantly higher than those of the control ODN group [(4.2 +/- 1.0)%, t = 24.12, P = 0.00] and blank control group [(3.1 +/- 1.2)%, t = 25.1, P = 0.00]. There was no significant differences in the proportion of IL-4 positive CD8 + T cells among different groups. When the E/T was 40:1 the killing capacity of PBMCs against the K562 cells was (19.5 +/- 1.0), significantly higher than those of the control ODN group (7.9 +/- 1.1, t = 19.9, P = 0.00) and blank control group (5.1 +/- 1.6, t = 21.9, P = 0.00), and the killing capacity of PBMCs against the autologous lung tumor cells was (29.8 +/- 2.1), significantly higher than those of the control ODN group (8.1 +/- 0.9, t = 36.9, P = 0.00) and blank control group (5.7 +/- 1.6, t = 35.7, P = 0.00). CONCLUSION: TLR9 signal takes part in the immunomodulation of PBMCs. The activation of TLR9 results in enhanced anti-tumor response in the PBMCs against autologous lung cancer cells and K562 cells.

Targeting toll-like receptor 9 with CpG oligodeoxynucleotides enhances anti-tumor responses of peripheral blood mononuclear cells from human lung cancer patients.

CpG-oligonucleotides (CpG-ODN), which induce signaling through Toll-like receptor 9 (TLR9), are currently under investigation as adjuvants in therapy against infections and cancer. However, whether the CpG-ODN alone could enhance the anti-tumor immunity and the underlying mechanisms remains unclear. Here, we investigated that stimulation of peripheral blood mononuclear cells (PBMCs) from human lung cancer patients with CpG-ODN induced proliferation responses of the PBMCs, accompanied by the elevated cytokine secretion, including IFN-alpha, IL-12 and TNF-alpha. In addition, after treatment with CpG-ODN, the cytotoxic activity of the PBMCs and the production of IFN-gamma in CD8(+) T cells were dramatically enhanced. Furthermore, we found that adoptive transfer of CpG-ODN treated PBMCs significantly inhibited the tumor progression in nude mice, which were challenged with the autologuous tumor cells from human lung cancer patients. Finally, we demonstrated that the inhibitory CpG ODN or chloroquine could dramatically abrogate the enhanced anti-tumor responses of the CpG ODN treated PBMCs. Our findings suggest that the CpG-ODN is promising as a preventive and therapeutic anti-tumor measure against pulmonary carcinoma.

[A study on the mechanisms of mycobacterial clearance induced by CpG-oligodeoxynucleotides in mice].

OBJECTIVE: To investigate the possible mechanisms of mycobacterial clearance induced by CpG-oligodeoxynucleotides (CpG-ODN) in mice. METHODS: Eight-week-old female BALB/c mice were treated with intraperitoneal CpG-ODN (30 microg), while the control mice with normal saline. After 2 weeks, the control mice and the CpG-treated mice were infected with Mycobacterium tuberculosis (1 x 10(6) colony-forming units, H(37)Rv strain) through the tail vein. At 3 weeks, 4 weeks and 6 weeks after mycobacterial infection, the lung and the spleen tissues were examined for histopathological changes. Real time-PCR was performed to measure the messenger RNA (mRNA) of interleukin (IL)-12, IL-18, interferon (IFN)-gamma, IL-4, IL-10 and inducible nitric oxide synthase (iNOS) in the tissues. The homogenates of lungs and spleens were cultured, and the colonies were counted after a 4 weeks incubation period at 37 degrees C. RESULTS: At 3 weeks and 4 weeks of mycobacterial infection, CpG-ODN-pretreated mice showed less mycobacterial burden in the lungs and the spleens than that in the control mice [(0 +/- 0) x 10(6) CFU/g vs (32 +/- 11) x 10(6) CFU/g, (0 +/- 0) x 10(6) CFU/g vs (10 +/- 4) x 10(6) CFU/g; (26 +/- 4) x 10(6) CFU/g vs (56 +/- 8) x 10(6) CFU/g, (4 +/- 3) x 10(6) CFU/g vs (27 +/- 8) x 10(6) CFU/g]. At 4 weeks of mycobacterial infection, CpG-ODN-pretreated mice displayed increased levels of IL-18 mRNA, IFN-gamma mRNA, iNOS mRNA [(3.6 +/- 0.5, 1.6 +/- 1.1, 0.32 +/- 0.14) vs (0.20 +/- 0.10, 23.17 +/- 4.72, 16.18 +/- 5.09)], and decreased level of IL-12p40 mRNA (5.66 +/- 0.64 vs 14.54 +/- 1.89), but there was no difference in the levels of IL-4 mRNA and IL-10 mRNA in the lungs between CpG-ODN-pretreated mice and the control mice [(0.30 +/- 0.09 vs 0.26 +/- 0.05), (0.28 +/- 0.05 vs 0.29 +/- 0.08)]. CpG-ODN-pretreated mice displayed increased levels of IL-18 mRNA, IFN-gamma mRNA, iNOS mRNA [(5.54 +/- 1.29 vs 0.79 +/- 0.36), (0.52 +/- 0.07 vs 0.21 +/- 0.06), (9.07 +/- 1.81 vs 5.97 +/- 1.44)], and decreased levels of IL-12p40 mRNA, IL-4 mRNA and IL-10 mRNA [(2.10 +/- 0.27 vs 5.07 +/- 0.39), (0.23 +/- 0.10 vs 1.21 +/- 0.26), (0.10 +/- 0.04 vs 0.57 +/- 0.13)] in the spleens as compared with the control mice. In CpG-ODN-pretreated mice, expression level of IFN-gamma mRNA in the lungs at 6 weeks post-infection was higher than that at 4 weeks post-infection (0.95 +/- 0.27 vs 0.32 +/- 0.14). CONCLUSION: The activation of Toll-like receptor-9 (TLR-9) with CpG-ODN could enhance murine mycobacterial clearance in vivo. TLR-9-induced anti-mycobacterial activity involves increased expression of IL-18, IFN-gamma, and iNOS but decreased expression of IL-4 and IL-10.

Functional expression of TLR9 is associated to the metastatic potential of human lung cancer cell: functional active role of TLR9 on tumor metastasis.

CpG-oligonucleotides (CpG-ODN), which induce signaling through Toll-like receptor 9 (TLR9), are widely used as adjuvants in therapy against cancer. However, tumor cells express functional TLR9 were recently reported and the immune effect of CpG ODN on tumor cells remains unclear. Here we investigated the direct effects of CpG ODN on human tumor cell line 95D cells using flow cytometric analysis and Western blotting. We found strongly high expression of TLR9 in 95D cells. Stimulation of 95D cells with CpG ODN induced significantly elevated secretion of IL-1alpha and IL-8, as well as the expression of CXCR4, ICAM-1 and MMP-2. Furthermore, the invasion of 95D cells and TLR9 modifying 95C cells were significantly enhanced by stimulation of CpG ODN, which could be abrogated by inhibitory CpG ODN and chloroquine. These results suggest that functionally active TLR9 is expressed on human tumor cell lines, and may represent a novel insight on the role of TIL9 agonist used in tumor immunotherapy.