HDFx: a novel biologic immunomodulator accelerates wound healing and is suggestive of unique regenerative powers: potential implications for the warfighter and disaster victims.

Recently, we reported on the discovery of a new, conserved biologic protein (35-40 KDa), termed HDFx, that protects rats, guinea-pigs, mice, and rabbits against lethal hemorrhage, endotoxins, intestinal ischemic-shock, and traumatic injuries. It was found to stimulate several arms of the immune system. The present report demonstrates, for the first time, that HDFx accelerates wound healing in two different models (excision wound model; and incision wound model) in rats. The results shown, herein, indicate that HDFx produces greater rates of wound contraction, greater tensile strength, and more rapid healing than controls. Our new data also show that this biologic increases hydroxyproline content of granulation tissue coupled with a reduction in superoxide dismutase (SOD). In addition, we show that HDFx increases the levels of serum ascorbic acid and stimulates the mononuclear cells of the reticuloendothelial system (RES). Overall, these data suggest that HDFx may possess unique regenerative powers. We, thus, believe that HDFx can be of great potential use in diverse types of wounds which, otherwise, could result in difficult to treat infections and thus prevent sepsis and loss of body parts from amputations.

HDFx: a novel biologic immunomodulator is therapeutically -effective in hemorrhagic and intestinal-ischemic shock: importance of microcirculatory-immunological interactions and their potential implications for the warfighter and disaster victims.

Recently, we have reported on the discovery of a new, conserved protein (35-40 kD), termed HDFx, that protects rats, guinea-pigs, mice and rabbits against lethal hemorrhage, endotoxins, and traumatic injury when given, systemically, as a pretreatment. HDFx was also found to stimulate several arms of the immune system. The present report demonstrates, for the first time, that HDFx ,when administered post-hemorrhage and post-intestinal ischemia shock -trauma, yields increased survival rates, elevates falling arterial blood pressures, possesses unique actions in the microvasculature, stimulates depressed RES phagocytosis (normally observed in animals and humans during blood loss, sepsis and trauma), and preserves cytokine levels in lymphocytes obtained from animals subjected to hemorrhage and traumatic shock. We believe that HDFx presents a potential brand new therapeutic approach:1)for the injured warfighter on the battlefield, 2)for victims of major disasters, 3)as an adjunct for patients undergoing high -risk surgical procedures commonly found in open-heart surgery, cancers, and in neurosurgeries. Use of HDFx could potentially allow oncologists to decrease chemotherapy dosing, while increasing patient survival chances.

A novel biologic immunomodulator, HDFx, protects against lethal hemorrhage, endotoxins and traumatic injury: potential relevance to emerging diseases.

For more than 125 years, it has been known that the RES, macrophages and the innate immune system play fundamental roles in host defense against pathogenic infections, trauma, hemorrhage, and combined injuries. Some years ago, we and others reported that the RES-macrophage system was intimately connected to resistance to these bodily stressors, among other injuries. We tested the hypothesis that induction of tolerance (either spontaneous, RES-stimulated, or drug-induced) might be associated with production of a yet-to-be-identified biologic host defense factor, which we have termed HDFx. The results presented, herein, demonstrate for the first time that: 1) the MW of this protein, HDFx, is approximately 35-40 KDa , larger than known defensin peptides and much smaller than the larger MW fibronectins and complement products; 2) we describe some of HDFx's physico-chemical characteristics; 3) approximately 80 % of HDFx's plasma biological activity is derived from macrophages; 4) about 15-20 % of its activity is derived from natural killer (NK) cells; 5) polymorphonuclear leukocytes are not a source of HDFx synthesis or release; 6) known stimulants of the RES-macrophage system (i.e., denatured human serum albumin, triolein, and choline chloride) effect phagocytic stimulation of macrophages and protection against endotoxins, trauma, and hemorrhage via synthesis and release of HDFx; 7) adaptation to lethal trauma is dependent on the biological activity of HDFx; and 8) repeated administration of purified HDFx to rats, over several months, does not produce any detectable pathologies. Lastly, the release of cytokines (i.e., IL-2,IL-6,IFN-gamma) from lymphocytes, after hemorrhage and trauma, at least in rodents, appears to be dependent on the available plasma levels of HDFx. Since it is present also in mice, guinea-pigs, and rabbits, we are tempted to speculate that HDFx could prove (if found in humans) to be useful against potential biothreats, new emerging diseases, high -risk surgical procedures, hospital-borne infections, and burn injuries, where the chances for superimposed bacterial infections present great risk.

Low extracellular magnesium ions induce lipid peroxidation and activation of nuclear factor-kappa B in canine cerebral vascular smooth muscle: possible relation to traumatic brain injury and strokes.

The present study was designed to test the hypothesis that administration of low extracellular levels of magnesium ions ([Mg(2+)](o)) to primary cultured cerebral vascular smooth muscle cells will cause lipid peroxidation, degradation of IkappaB-alpha, and activation of nuclear transcription factor kappa B (NF-kappaB) in cultured cerebral vascular smooth muscle cells. Low [Mg(2+)](o) (0, 0.15, 0.3 and 0.48 mM) resulted in concentration-dependent rises in malondialdehyde (MDA) in as little as 3 h after exposure to low [Mg(2+)](o), rising to levels 3-12xnormal after 18-24 h; the lower the [Mg(2+)](o), the higher the MDA level. Using electrophoretic mobility shift assays and specific antibodies, low [Mg(2+)](o) caused two DNA-binding proteins (p50, p65) to rise in nuclear extracts in a concentration-dependent manner. High [Mg(2+)](o) (i.e. 4.8 mM) downregulated p50 and p65. Using a rabbit antibody, IkappaB phosphorylation (and degradation) was stimulated by low [Mg(2+)](o) (in a concentration-dependent manner) and inhibited by a low concentration of the NF-kappaB inhibitor, pyrrolidine dithiocarbamate. These new biochemical and molecular data indicate that low [Mg(2+)](o), in concentrations found in the blood of patients, after traumatic brain injury (TBI) and diverse types of strokes, can elicit rapid lipid peroxidation and activation of NF-kappaB in cerebral vascular smooth muscle cells. The present results, when viewed in light of other recently published data, suggest that low [Mg(2+)](o)-induced lipid peroxidation and activation of NF-kappaB play important roles in TBI and diverse types of strokes.

Inhibitor of nuclear factor-Kappa B activation attenuates venular constriction, leukocyte rolling-adhesion and microvessel rupture induced by ethanol in intact rat brain microcirculation: relation to ethanol-induced brain injury.

The present study was designed to test the hypothesis that acute, local administration of a specific inhibitor of nuclear factor-Kappa B activation (which prevents rapid proteolysis of IKB-alpha) will attenuate cerebral (cortical) venular constrictions, leukocyte-endothelial wall interactions and postcapillary damage induced by medium to high concentrations of ethanol in the intact rat brain. Perivascular or i.p. administration of ethanol (100, 250 mg/dl) to the intact rat brain resulted in concentration-dependent venular vasospasm, rolling and adherence of leukocytes to venular walls and rupture of postcapillary venules with focal hemorrhages. Superfusion of the in-situ brain with N(alpha)-L-tosyl-L-phenylalanine chloromethyl ketone (TPCK), a specific inhibitor of IKB-alpha proteolysis, attenuated greatly the spasmogenic, leukocyte rolling-endothelial cell adhesion and postcapillary hemorrhages induced by ethanol. These new data suggest that inhibition of alcohol-inducible degradation of IKB-alpha by TPKC can prevent much of the adverse microvascular actions of ethanol in the intact rat brain. Moreover, these new in-situ results suggest that activation of nuclear factor-Kappa B seems to play a major modulatory role in the adverse cerebral vascular actions of concentrations of alcohol found in the blood of alcohol-intoxicated subjects and human stroke victims.

Role of leukocytes in ethanol-induced microvascular injury in the rat brain in situ: potential role in alcohol brain pathology and stroke.

Effects of acute and chronic alcohol ethanol administration on in vivo microvascular-leukocyte dynamics was studied in brains of naive and leukocyte-depleted rats by direct, quantitative intravital high-resolution TV microscopy, fluorescence microscopy and myeloperoxidase staining. Administration of alcohol produced dose-dependent venular vasospasm, and rolling and adherence of leukocytes to venular walls; leukocyte velocity concomitantly decreased. Intermediate to high doses of ethanol resulted in infiltration of leukocytes and macrophages across venular walls, and concentration-dependent increases in myeloperoxidase staining in parenchyma, and rupture of postcapillary venules with focal hemorrhages. Use of phosphorus 31-nuclear magnetic resonance spectroscopy on intact animals revealed that the latter were associated with whole brain losses in intracellular levels of ATP and phosphocreatine with concomitant rises in intracellular inorganic phosphate and hydrogen ion concentration. Vinblastine-depletion of circulating leukocytes prevented or ameliorated greatly the alcohol-induced microvascular damage and proinflammatory-like reactions. These new results, when viewed in light of other recent findings, suggest that alcohol-induced cerebral vascular and brain damage is dependent, to a large extent, on recruitment of leukocytes.

Sphingomyelinase and ceramide analogs induce vasoconstriction and leukocyte-endothelial interactions in cerebral venules in the intact rat brain: Insight into mechanisms and possible relation to brain injury and stroke.

This study was designed to test the hypothesis that the sphingomyelin-ceramide signaling pathway may be important in proinflammatory-like responses in the intact brain. Effects of neutral sphingomyelinase (N-SMase), ceramide analogs, phosphorylcholine and ceramide metabolites were studied on rat brain cerebral (cortical) venule lumen sizes, leukocyte rolling, velocity and endothelial cell wall adhesion, microvessel permeability, microvessel rupture and focal hemorrhages using in vivo high resolution TV microscopy. Perivascular and close intra-arterial administration of N-SMase, C(2)-, C(8)-, and C(16)-ceramide, but not either phosphorylcholine, C(6)-ceramide, nervonic (C(24):1) ceramide, lignoceric (C(24):0) ceramide, C(8)-ceramide-1-phosphate, glucosylceramide or 1-0-acylceramide, resulted in potent, concentration-dependent constriction (and spasm) of cortical venules, followed by increased leukocyte rolling, decreased leukocyte velocities, increased leukocyte-endothelial wall adhesion, increased venular wall permeability, postcapillary venule rupture and, often, micro-hemorrhaging at high concentrations; angiotensin II, serotonin and PGF(2alpha) didn't demonstrate these characteristics. Pretreatment with either one of three different antioxidants, including inhibitors of NF-kappaB activation, or two different Ca(2+) channel blockers either prevented or attenuated the adverse venular effects of N-SMase and the ceramides. Likewise, pretreatment with either a PKCalpha-beta antagonist or a MAP kinase antagonist also attenuated the adverse venular effects. These results suggest that N-SMase and several ceramides can result in potent venular cerebrovasospasm, leukocyte-endothelial chemoattraction, and microvessel wall permeability changes in the intact rat brain. These proinflammatory-like actions suggest that N-SMase and ceramides could produce brain-vascular damage by reperfusion injury triggering lipid peroxidation, release of reactive oxygen species and activation of diverse signaling pathways: PKCalpha-beta isozymes, MAP kinase and NF-kappaB.

Optical spectroscopy and prevention of deleterious cerebral vascular effects of ethanol by magnesium ions.

Previously, it has been suggested that acute ethanol (alcohol) administration can result in concentration-dependent vasoconstriction and decreased cerebral blood flow. Here, we present in vivo results using rapid (240 nm/min) optical backscatter measurements, with an intact cranial preparation in the rat, indicating that acute infusion of ethanol directly into the rat brain rapidly produces dose-dependent vasoconstriction of the cerebral microcirculation associated with a pronounced reduction in tissue blood content, pronounced rises in deoxyhemoglobin, significantly increased levels of reduced cytochrome oxidase and microvascular damage as the dose increases. Furthermore, we present in vivo experiments demonstrating the capability of magnesium ions (Mg(2+)) to attenuate and prevent these deleterious responses. Optical backscatter spectra (500-800 nm) were obtained by directing a single sending and receiving fiber to a portion of the left parietal cranium (in anesthetized rats), shaved to a translucent appearance to facilitate optical penetration. In the absence of added Mg(2+), infusion of a 10% solution of ethanol at 0.34 ml/min ( approximately 26.8 mg/min) produced prompt vasoconstriction as evidenced by a greater than 90% loss of oxyhemoglobin from the field-of-view and increases in levels of reduced cytochrome oxidase to between 50% and >90%. These effects were partially, to nearly completely, attenuated by the addition of MgCl(2) to the infusate containing added ethanol. Of special interest was the observation that attenuation of the vasoconstrictive effect of ethanol by Mg(2+) persisted despite a subsequent ethanol challenge without added Mg(2+). The results obtained demonstrate that, depending on dose, ethanol can produce prompt and severe vasoconstriction of the intact cerebral microcirculation and that infusion of moderate doses of Mg(2+) can largely attenuate and prevent this response. We conclude that appreciable, graded changes in cerebral cytochrome oxidase aa(3), blood volume and the state of hemoglobin occur at minimal tissue levels of ethanol which can be modulated by Mg(2+).

Ethanol induces rapid lipid peroxidation and activation of nuclear factor-kappa B in cerebral vascular smooth muscle: relation to alcohol-induced brain injury in rats.

The present study was designed to test the hypothesis that acute administration of alcohol (ethanol) to primary cultured cerebral vascular smooth muscle cells will cause lipid peroxidation, inhibition of IkappaB phosphorylation, and inhibition of nuclear transcription factor-kappa B (NF-kappaB). Ethanol (10, 25, 100 mM) resulted in concentration-dependent rises in malondialdehyde in as little as 30-45 min after exposure to the alcohol, rising to levels 2.5-10x normal after 18-24 h. Using EMSA assays and specific antibodies, ethanol caused three DNA-binding proteins (p50, p65, c-Rel) to rise in nuclear extracts in a concentration-dependent manner. Using a rabbit antibody, IkappaB phosphorylation (and degradation) was stimulated by ethanol (in a concentration-dependent manner) and inhibited by a low concentration of the NF-kappaB inhibitor, pyrrolidine dithiocarbamate. These new biochemical and molecular data indicate that ethanol, even in physiologic concentrations, can elicit rapid lipid peroxidation and activation of NF-kappaB in cerebral vascular muscle cells. The present results when viewed in light of other recently published data suggest that ethanol-induced lipid peroxidation and activation of nuclear transcription factors probably play important roles in alcohol-induced brain-vascular damage, neurobehavioral actions and stroke.