Inhaled vs subcutaneous effects of a dual IL-4/IL-13 antagonist in a monkey model of asthma.

BACKGROUND: Pitrakinra is a recombinant protein derived from human interleukin-4 (IL-4) that binds to IL-4Ralpha and acts as a competitive antagonist of IL-4 and IL-13. The studies reported here compare the dose-ranging effects of pitrakinra on allergen-induced airway hyperresponsiveness (AHR) and airway eosinophilia when administered subcutaneously (s.c.) or by inhalation to the Ascaris suum-sensitive cynomolgus monkey for the purpose of elucidating the primary site of pitrakinra's anti-asthmatic action. METHODS: Airway responsiveness to inhaled methacholine and bronchoalveolar lavage cell composition was determined before and after three allergen exposures with a 1-week course of twice-daily (b.i.d.) s.c. or inhaled pitrakinra or placebo treatment. RESULTS: Treatment with s.c. pitrakinra significantly reduced allergen-induced AHR, with a maximum effect of a 2.8- to 3.8-fold increase in methacholine PC(100) relative to control (P < 0.05) observed at b.i.d. s.c. doses of 0.05-0.5 mg/kg. Inhaled pitrakinra also significantly reduced AHR with a similar maximum effect of a 2.8- to 3.2-fold increase in methacholine PC(100) relative to control (P < 0.05) at nominal b.i.d. doses of 3-100 mg. The maximal effect on AHR following inhalation was observed at a plasma concentration which exhibited no efficacy via the subcutaneous route. The effect of pitrakinra on lung eosinophilia was not statistically significant following either route of administration, although lung eosinophil count was reduced in all studies relative to control. CONCLUSION: Local administration of pitrakinra to the lung is sufficient to inhibit AHR, one of the cardinal features of asthma, indicating the therapeutic potential of inhaled pitrakinra in the treatment of atopic asthma.

A murine IL-4 receptor antagonist that inhibits IL-4- and IL-13-induced responses prevents antigen-induced airway eosinophilia and airway hyperresponsiveness.

The closely related Th2 cytokines, IL-4 and IL-13, share many biological functions that are considered important in the development of allergic airway inflammation and airway hyperresponsiveness (AHR). The overlap of their functions results from the IL-4R alpha-chain forming an important functional signaling component of both the IL-4 and IL-13 receptors. Mutations in the C terminus region of the IL-4 protein produce IL-4 mutants that bind to the IL-4R alpha-chain with high affinity, but do not induce cellular responses. A murine IL-4 mutant (C118 deletion) protein (IL-4R antagonist) inhibited IL-4- and IL-13-induced STAT6 phosphorylation as well as IL-4- and IL-13-induced IgE production in vitro. Administration of murine IL-4R antagonist during allergen (OVA) challenge inhibited the development of allergic airway eosinophilia and AHR in mice previously sensitized with OVA. The inhibitory effect on airway eosinophilia and AHR was associated with reduced levels of IL-4, IL-5, and IL-13 in the bronchoalveolar lavage fluid as well as reduced serum levels of OVA-IGE: These observations demonstrate the therapeutic potential of IL-4 mutant protein receptor antagonists that inhibit both IL-4 and IL-13 in the treatment of allergic asthma.

A T-cell-selective interleukin 2 mutein exhibits potent antitumor activity and is well tolerated in vivo.

Human interleukin 2 (IL-2; Proleukin) is an approved therapeutic for advanced-stage metastatic cancer; however, its use is restricted because of severe systemic toxicity. Its function as a central mediator of T-cell activation may contribute to its efficacy for cancer therapy. However, activation of natural killer (NK) cells by therapeutically administered IL-2 may mediate toxicity. Here we have used targeted mutagenesis of human IL-2 to generate a mutein with approximately 3,000-fold in vitro selectivity for T cells over NK cells relative to wild-type IL-2. We compared the variant, termed BAY 50-4798, with human IL-2 (Proleukin) in a therapeutic dosing regimen in chimpanzees, and found that although the T-cell mobilization and activation properties of BAY 50-4798 were comparable to human IL-2, BAY 50-4798 was better tolerated in the chimpanzee. BAY 50-4798 was also shown to inhibit metastasis in a mouse tumor model. These results indicate that BAY 50-4798 may exhibit a greater therapeutic index than IL-2 in humans in the treatment of cancer and AIDS.

Molecular basis of hypoxanthine-guanine phosphoribosyltransferase deficiency in thirteen Spanish families.

We have determined the molecular basis of hypoxanthine-guanine phosphoribosyltransferase (HPRT; HPRT1) deficiency in eight Lesch-Nyhan patients and in five partially HPRT deficient patients with mild to severe neurologic symptoms. Eight of these thirteen mutations have not been previously described. HPRT Zaragoza II (a GG insertion in exon 2), HPRT Murcia (an AG deletion in exon 4), HPRT Asturias (a A deletion in exon 4) and HPRT Cartagena (a A insertion in exon 6) cause a frame-shift resulting in a premature stop codon. HPRT Sevilla is a splice-site mutation resulting in exon 8 skipping in the HPRT mRNA. HPRT Huelva, Madrid II and Zaragoza I are point mutations that result in single amino-acid changes in the mutated HPRT protein (118G-->A, G40R; 143G-->A, R 48 H; 397G-->A, V133 M, respectively). Three mutations have been previously described in unrelated families, and two mutations have been already published. All mutations that resulted in truncated proteins corresponded to patients with the Lesch-Nyhan phenotype. Characterization of the HPRT mutation allowed us to make carrier detection in 33 women and prenatal diagnosis in two fetuses. Hum Mutat 15:383, 2000.

Empirical fitting with polycon II lenses.

Historically, rigid gas permeable (RGP) lens parameters have been determined through trial fitting. Nevertheless, practitioners would likely welcome the opportunity to empirically fit RGP lenses if they could be confident of the outcome. This clinical investigation sought to evaluate the potential success of empirically fitting 9.0 mm Polycon II lenses. Based on both objective and subjective outcomes, this study suggests that empirically fitting the larger 9.5 mm Polycon II design, in combination with a lid attachment approach, would yield greater initial patient satisfaction.

A murine skeletal muscle ischemia-reperfusion injury model: differential pathology in BALB/c and DBA/2N mice.

Ischemia-reperfusion injuries can occur with diseases such as myocardial infarction and stroke and during surgical procedures such as organ transplantation and correction of aortic aneurysms. We developed a murine model to mimic abdominal aortic aneurysm repair with cross-clamping of the aorta distal to the renal artery. After model development, we compared the normal complement BALB/c mouse with the C5-deficient DBA/2N mouse. To assess quantitative differences, we measured neuromuscular function up to 72 h after ischemia with a subjective clinical scoring system, as well as plasma chemistries, hematology, and histopathology. There were significant increases in clinical scores and creatine phosphokinase, lactate dehydrogenase, and muscle histopathology scores in BALB/c mice compared with those in DBA/2N mice and sham-surgery mice. Muscle histopathology scores of the cranial tibialis and quadriceps correlated well with clinical signs, creatine phosphokinase, and lactate dehydrogenase, and indicated the greatest pathology in these muscle groups. We developed a murine model of skeletal muscle ischemia-reperfusion injury that can utilize the benefits of murine genetic and transgenic models to assess therapeutic principles of this model. Additionally, we have shown a significant reduction in clinical signs, plasma muscle enzyme concentrations, and muscle pathology in the C5-deficient DBA/2N mouse in this model.

An immune cell-selective interleukin 4 agonist.

Interleukin 4 (IL-4) is a pleiotropic cytokine. Of the cell types responsive to IL-4, T cells express one IL-4 receptor (IL-4R) type, IL-4Ralpha/IL-2Rgamma (class I IL-4R), whereas endothelial cells express another type, IL-4Ralpha/IL-13Ralpha (class II IL-4R). It was hypothesized that IL-4 variants could be generated that would be selective for cell types expressing the different IL-4Rs. A series of IL-4 muteins were generated that were substituted in the region of IL-4 implicated in interactions with IL-2Rgamma. These muteins were evaluated in T cell and endothelial cell assays. One of these muteins, containing the mutation Arg-121 to Glu (IL-4/R121E), exhibited complete biological selectivity for T cells, B cells, and monocytes, but showed no activity on endothelial cells. Receptor binding studies indicated that IL-4/R121E retained physical interaction with IL-2Rgamma but not IL-13Ralpha; consistent with this observation, IL-4/R121E was an antagonist of IL-4-induced activity on endothelial cells. IL-4/R121E exhibits a spectrum of activities in vitro that suggest utility in the treatment of certain autoimmune diseases.

Expression of vascular cell adhesion molecule-1 by vascular endothelial cells in immune and nonimmune inflammatory reactions in the skin.

Expression of VCAM-1 was compared with that of E-selectin in cytokine-induced lesions and in delayed-type hypersensitivity reactions to tuberculin purified protein derivative (PPD) in pig skin. Lumenally expressed Ags were quantified by measuring localization in skin of i.v. injected (111)In-mAb 10.2C7 (anti-vascular cell adhesion molecule-1 (anti-VCAM-1), (125)I-mAb 1.2B6 (anti-E-selectin), and (99m)Tc-MOPC21 (control IgG1). Anti-VCAM-1 mAb uptake was greater following intradermal (i.d.) injection of TNF-alpha than following injection of IL-1, while the two cytokines induced similar uptake of anti-E-selectin. In immunologically naive pigs there was no detectable increase in anti-VCAM-1 after i.d. injection of PPD, although anti-E-selectin uptake was increased at 3 and 6 h. In contrast, i.d. injection of PPD in sensitized pigs led to increased uptake of both anti-VCAM-1 and anti-E-selectin at 6, 8, 24, and 48 h, each of which was significantly greater than the uptake of control IgG1 into the same lesions (each p < 0.01). Anti-TNF-alpha mAb abolished the increased uptake of anti-VCAM-1 3 and 8 h following i.d. injection of PPD in sensitized pigs and significantly inhibited uptake at 24 h (p = 0.0025), but did not significantly reduce uptake of anti-E-selectin. We conclude that in this delayed-type hypersensitivity model 1) E-selectin expression by endothelial cells follows sequential Ag nonspecific and immune-specific phases, 2) increased VCAM-1 expression by endothelial cells is only seen in sensitized animals, and 3) expression of VCAM-1 appears to be relatively more dependent on TNF-alpha than E-selectin. Differential expression of E-selectin and VCAM-1 may influence the leukocytic infiltrate during the course of nonspecific and immune-specific inflammatory reactions.

Endothelial activation in monosodium urate monohydrate crystal-induced inflammation: in vitro and in vivo studies on the roles of tumor necrosis factor alpha and interleukin-1.

OBJECTIVE: There is relatively little direct evidence for the roles of interleukin-1 (IL-1) and tumor necrosis factor alpha (TNF alpha) in activating endothelium in vivo. The aim of this study was to use in vitro and in vivo models to investigate the contribution of these cytokines to both E-selectin expression and the recruitment of polymorphonuclear cells (PMN) in monosodium urate monohydrate (MSU) crystal-induced inflammation. METHODS: MSU crystals were incubated with freshly isolated mononuclear cells, after which the harvested supernatants were tested for their ability to induce E-selectin expression during coculture with human umbilical vein endothelial cells. Subsequent experiments were performed with the addition of neutralizing anticytokine antibodies/antisera. The role of TNF alpha was then studied in an MSU crystal-induced monarthritis model, in the presence or absence of anti-TNF alpha (5 mg/kg intravenously). 99mtechnetium (99mTc)-labeled PMN cells and (111)indium (111In)-labeled anti-E-selectin monoclonal antibody (MAb) 1.2B6 were intravenously administered 4 hours after intraarticular injection to quantify PMN recruitment and E-selectin expression in inflamed joints. RESULTS: MSU crystals were a potent stimulus for IL-1 and TNF alpha production by monocytes in vitro, and these cytokines fully accounted for MSU crystal-stimulated, monocyte-mediated endothelial activation. In the MSU crystal-induced monarthritis model, TNF alpha blockade was very effective in suppressing both E-selectin expression and PMN emigration into the inflamed joints, as judged by gamma-camera image analysis and postmortem tissue counting following the intravenous injection of 99mTc-PMN and 111In-anti-E-selectin MAb. CONCLUSION: IL-1 and TNF alpha appear to be the only factors released by monocytes following incubation with MSU crystals, which induce E-selectin expression in vitro. Anti-TNF alpha is effective in suppressing endothelial activation and PMN recruitment in vivo E-selectin imaging can be used to assess the endothelial response to therapy and may prove useful for clinical studies.

Metabolic cooperation in the selection of thioguanine-resistant mutants does not occur with the human B-lymphoblastoid cell TK6.

Selection for thioguanine resistant mutants in the human B-lymphoblastoid cell TK6 yields the same results in both round and flat bottom 96-well microtiter plates. These results suggest that metabolic cooperation is not an issue in these cells and show that round bottom wells can be used in place of flat bottom wells.

Feasibility of fitting contact lenses with apical clearance in keratoconus.

Despite the wide variety of rigid contact lens fitting philosophies for the visual correction of keratoconus, questions remain, including which approach-flat, divided support, or steep-contributes the most toward the preservation of a clear cornea. One goal of the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Pilot Study was to determine the feasibility of managing early keratoconus patients with apical clearance rigid contact lenses. Of 30 keratoconus patients identified with at least 1 nonscarred cornea, 17 patients (30 eyes) were randomly assigned to a steep lens fitting protocol. After trial fitting with a standardized lens design demonstrating minimum apical clearance, lenses were dispensed whose base curve was 0.2 mm steeper than the minimum apical clearance lens. Patients were re-evaluated on a quarterly schedule concluding at 12 months. Changes in keratometry between baseline and 12 months identified unequal steepening of the flat and steep corneal curvatures, suggestive of corneal molding. Best corrected rigid lens visual acuity measures illustrated no significant changes over the course of the study. Clinically significant corneal compromise was transiently observed in some patients. Only 1 of 22 eyes completing the pilot study and fitted with apical clearance developed mild corneal scarring.

The interaction of alpha 1-proteinase inhibitor and tissue kallikrein in controlling allergic ovine airway hyperresponsiveness.

We reported previously that the development of airway hyperresponsiveness (AHR) 24 h after antigen challenge in allergic sheep was associated with increased tissue kallikrein activity (TK) and decreased alpha-1-proteinase inhibitor (alpha 1-PI) activity in bronchoalveolar fluid (BAL). The inverse correlation between TK and alpha 1-PI in these experiments suggested that administration of alpha 1-PI might reduce TK activity and block AHR. To test this hypothesis, airway responsiveness, as determined by calculating the cumulative carbachol breath units (BU) that increased specific lung resistance by 400% (PC400), was measured before and 24 h after aerosol challenge with Ascaris suum antigen in seven sheep hypersensitive to this antigen. On the next day, 30 min before the 24 h PC400 measurement, the sheep were treated with either aerosol alpha 1-PI (Prolastin, 10 mg/5 ml) or denatured (DN) prolastin (10 mg/5 ml), which had only 10% of its original activity. BAL was also performed before and 24 h after challenge for the measurement of TK and alpha 1-PI activity. Treatment with DN-Prolastin at 24 h after antigen challenge did not block antigen-induced AHR: PC400 fell from a baseline (mean +/- SE) of 26.0 +/- 3.2 BU to 11.2 +/- 1.5 BU after challenge (p < 0.05). This AHR was associated with increased TK (363%, p < 0.05) and decreased alpha 1-PI activity (65%, p < 0.05). Prolastin treatment at 24 h blocked the AHR: PC400 was 21.0 +/- 2.8 before and 23.2 +/- 3.7 after challenge (p < 0.05 versus DN-Prolastin) and the changes in BAL TK (28% increase) and alpha 1-PI activities (15% increase) were not different from baseline (both p < 0.05 versus DN-Prolastin). There was a significant inverse correlation between alpha 1-PI activity and TK activity in BAL, as well as the changes between baseline and 24 h in alpha 1-PI activity and TK activity in BAL Pretreatment (30 min before antigen challenge) with Prolastin also protected against the antigen-induced AHR. The effect of Prolastin was also seen against aerosol challenge with high-molecular-weight kininogen (HMWK), a substrate of TK. HMWK caused bronchoconstriction which was blocked by Prolastin (p < 0.05), and the bradykinin B2 antagonist, NPC-567 (indicating that kinins were generated), but not DN-Prolastin or the elastase inhibitor, ICI 200, 355. Although the negative association between alpha 1-PI activity and TK activity identified in this study does not prove cause and effect, our findings do raise the possibility that in vivo alpha 1-PI may regulate TK activity and allergen-induced AHR.

Standardized rigid contact lens fitting protocol for keratoconus.

Keratoconus is typically managed by a variety of rigid contact lens fitting techniques and lens designs. The two most fundamental fitting techniques are apical corneal touch (including divided or three-point touch) and apical clearance. In the course of designing a multi-center study of keratoconus patients, a standardized keratoconus fitting protocol was developed. All contact lens parameter options are uniform except for base curve and secondary curve radii, which are determined by interpretation of fluorescein patterns using the CLEK Study trial lens set and protocol. The initial trial lens's base curve is the average keratometric reading; sequentially steeper lenses are applied until definite apical clearance is observed. We have evaluated the feasibility of this standardized fitting protocol on 30 keratoconus patients. Our results suggest that we have developed a standardized contact lens fitting set and fitting protocol to simplify contact lens management in patients with mild to moderate keratoconus.

IL-4 induced leucocyte trafficking in cynomolgus monkeys: correlation with expression of adhesion molecules and chemokine generation.

BACKGROUND: Interleukin-4 (IL-4) is an immunoregulatory cytokine which has a wide variety of effects on immune cell function. In addition, recent studies suggest that IL-4 may have effects on other cells including endothelial cells in terms of the regulation of adhesion molecule expression and leucocyte extravasation from the vascular space to sites of tissue inflammation. Consequently, IL-4 may have an important role in the pathogenesis of allergic inflammation and disease. OBJECTIVE: The purpose of this study was to learn more about the potential role of IL-4 in inflammatory disease, specifically in regard to the potential of IL-4 to induce the expression of adhesion molecules on vascular endothelial cells and promote the adherence and transmigration of circulating leucocytes to sites of tissue inflammation. METHODS: Single subcutaneous injections of human IL-4 were administered to cynomolgus monkeys and tissue biopsy samples were obtained and analysed for adhesion molecule expression on vascular endothelium and inflammatory cell infiltrates. In another series of experiments, multiple subcutaneous injections of human IL-4 were administered (bid on four consecutive days) and the effects on peripheral blood leucocytes and plasma levels of various cytokines and chemokines were examined. RESULTS: Intradermal injection of IL-4 induced the expression of vascular cell adhesion molecule-1 (VCAM-1) on cutaneous vascular endothelium that was present at 8 hr and persisted out to 24 h post injection. The expression of VCAM-1 was associated with an inflammatory cell infiltrate comprised of granulocytes and mononuclear cells. Multiple injections of IL-4 resulted in a dose-related decrease in the relative percentage and total number of circulating lymphocytes and an increase in circulating neutrophils (4.6 +/- 1-2.1 +/- 0.2 x 10(6)/mL and 1.7 +/- 0.3-7.0 +/- 1 x 10(6)/mL, respectively). Analysis of cell surface markers by flow cytometry revealed a transient decrease in the number of CD4+T lymphocytes and a sustained decrease in CD16+ cells. In addition, IL-4 administration resulted in a large increase in plasma MCP-1 concentration. CONCLUSION: This is the first study to demonstrate an acute effect of IL-4 consistent with lymphocyte trafficking out of the vascular space, the induction of VCAM-1 expression on vascular endothelium and increases in plasma levels of MCP-1 in vivo. We suggest that IL-4 may be involved in the early recruitment of mononuclear cells to sites of tissue inflammation by the upregulation of VCAM-1 expression on vascular endothelium and the generation and release of potent chemoattractants.

Anterior hydrogel lens deposits: polished vs. unpolished surfaces.

Traditionally, lathe cut hydrogel lenses receive both back and front surface polishing to eliminate any surface irregularities that might serve as potential attachment sites for lens deposits or even microorganisms. However, with the advent of newer more technologically advanced lathing equipment, the need for lens polishing may require renewed justification. This study sought to compare, by scanning electron microscopy (SEM), anterior lens surface deposit formation on polished and unpolished 55% water hydrogel lenses. A total of 10 subjects wore in 1 eye (control) a lens with both front and back lens surfaces polished and on the other eye (test) a lens with only the back lens surface polished for a period of 2 weeks on a daily wear basis. Each lens was then scanned (using SEM), with 3 separate regions photographed at 30x using a 10 kV electron source. Using a Wilcoxon Signed-Ranks test on the differences between average deposit ratings for the polished and the unpolished lenses, by subject pair, we failed to reject the null hypothesis that the difference was zero.

Thromboxane-blocked swine as an experimental model of severe intravascular inflammation and septic shock.

The cardiopulmonary response elicited by intravenous bacteria or endotoxin is well characterized in swine and has two major components. The first represents the acute pulmonary and broncho-constrictive phase (0-2 h) and the second phase (3-8 h) represents increased microvascular permeability, hypotension, and enhanced leukocyte-endothelial adhesion. The pulmonary vasoconstriction and bronchoconstriction of phase 1 results in acute pulmonary hypertension and airway dysfunction, which may result in rapid mortality. Because this acute pulmonary response may not mimic the development of human septic shock, we sought to block this early phase and examine the role of tumor necrosis factor in the latter septic phase (3-8 h). Employing a thromboxane A2 (TXA2) receptor antagonist (BAY U 3405) in the presence of LD100 Escherichia coli challenge, we blocked the acute pulmonary hypertensive phase and prevented early mortality, however, TXA2 blockade did not affect the latter development of septic shock and death. This latter lethal phase, characterized by prolonged leukopenia, was blocked in a dose-dependent manner by tumor necrosis factor monoclonal antibody. We conclude that the TXA2-blocked E. coli-challenged swine may provide a novel animal model in which to investigate the pathophysiology of acute septic shock.

Contribution of specific cell-adhesive glycoproteins to airway and alveolar inflammation and dysfunction.

Using various animal models of toxic or antigenic-induced airway inflammation, we have demonstrated that adhesion molecules play an important role in the recruitment, retention, and site-specific activation of inflammatory cells within the airways. Furthermore, we have shown that cytokines may contribute to inflammatory responses in the airways by enhancing the expression of adhesion molecules on respiratory epithelial cells.

Parameter consistency in disposable lenses.

An evaluation of parameter consistency and edge defects as they might relate to premature lens fracture was undertaken for 2 disposable lens types, 50 Johnson & Johnson Acuvue lenses and 50 Wesley-Jessen FreshLook lenses. Diameter measurements varied from 13.97 to 14.48 mm (mean = 14.28 mm, SD = 0.138 mm) for Acuvue and 14.30 to 14.63 mm (mean = 14.41 mm, SD = 0.064 mm) for FreshLook. Based on previously reported information, these diameter variations for Acuvue may be sufficient to affect lens fitting characteristics. Calculated back surface sagittal depth varied from 3.27 to 3.38 mm (mean = 3.32, SD = 0.029 mm) for Acuvue and 3.68 to 3.87 mm (mean = 3.75 mm, SD = 0.039 mm) for FreshLook. Center thickness was generally consistent across the power range evaluated (-0.50 to -4.00 D) for the FreshLook lenses, and appeared to increase significantly for low minus powers for the Acuvue lenses. Twenty-one (44%) Acuvue lenses and 6 (12%) FreshLook lenses showed edge defects that might contribute to premature lens fracture.