Plasmid-mediated carbapenem-hydrolyzing enzyme KPC-2 in an Enterobacter sp.

A strain of an Enterobacter sp. with reduced susceptibility to imipenem, which produced a plasmid-mediated class A carbapenem-hydrolyzing enzyme, KPC-2 beta-lactamase, was isolated from a patient with sepsis at a Boston hospital. This is the first report of the production of a plasmid-encoded KPC-2 beta-lactamase by an Enterobacter sp.

A comparison of the intubation conditions between mivacurium and rocuronium during balanced anesthesia.

BACKGROUND: Comparisons of the intubation conditions with mivacurium and rocuronium from previous reports are confounded by the use of varied induction regimens. The authors compared intubation conditions of mivacurium, rocuronium, and a placebo at 90 s and their recovery profiles during anesthesia with nitrous oxide, oxygen, and propofol. METHODS: After induction with midazolam, fentanyl, and propofol in a randomized blinded study, 100 patients received one of the following treatments: 0.25 mg/kg mivacurium in divided doses (0.15 mg/kg followed by 0.1 mg/kg 30 s later); 0.45, 0.6, 0.9, or 1.2 mg/kg rocuronium; or placebo. Evoked thumb adduction was measured throughout. Intubation was attempted 90 s after the initial dose of mivacurium and other treatment doses by a "blinded" physician. Intubating conditions were graded as excellent, good, poor, or not possible. Spontaneous recovery was studied until a 25% initial twitch height was reached. Mean arterial blood pressure and heart rate changes between groups were determined before induction through 6 min after administration of the study drugs. RESULTS: There were no important changes or intergroup differences in mean arterial blood pressure and heart rate. Intubation conditions were good or excellent for both mivacurium and rocuronium at the 0.9 mg/kg dose (93%) and at the 1.2 mg/kg dose (100%). Rocuronium at the 0.6 mg/kg dose was excellent in 27% of patients, whereas rocuronium at the 0.45 mg/kg dose had the least number of excellent conditions and the most poor or not possible assessments. Patients given placebo could not be intubated. Times to maximum blockade for 0.9 and 1.2 mg/kg rocuronium were the shortest. The times to 25% recovery for 0.6 mg/kg rocuronium (mean +/- SD = 27 +/- 8.6 min), 0.9 mg/kg (43.1 +/- 10.8), and 1.2 mg/kg (62.3 +/- 17.4 min) were significantly longer than were those for mivacurium (17.4 +/- 6.2 min). CONCLUSIONS: Mivacurium in a 0.25 mg/kg divided dose and rocuronium at 0.9 mg/kg and 1.2 mg/kg provide good or excellent intubation conditions at 90 s in most patients. Rocuronium was faster in onset at the higher doses (0.9 and 1.2 mg/kg) but had more prolonged recovery times to 25% single twitch height.

Binding and transport of transthyretin-gold by the endothelium of the rat choriocapillaris.

The photoreceptors of the neural retina require retinol for synthesis of rhodopsin. In the plasma, retinol is bound to retinol binding protein which is carried by transthyretin (TTR; formerly called prealbumin). It is unknown whether, or how, retinol carrier proteins cross the endothelium of the choriocapillaris, the blood supply to the outer neural retina. This was examined in the present study with TTR-gold probes perfused into rats and localized by electron microscopic techniques. TTR-gold, often in clusters, was localized to diaphragmed fenestrae, parajunctional areas, coated pits, transendothelial channels, multivesicular bodies, and to vesicles close to the Golgi apparatus. The probe was also identified at the luminal and abluminal fronts and the interior of transendothelial channels in an apparent sequence of transit. TTR-gold was also found in a series of interconnected vesicles adjacent to the abluminal side of the endothelium. Localizations were not seen when rat albumin fraction V was substituted for TTR and when the rats were perfused with Pronase E before labeling with TTR-gold. These observations indicate that binding and receptor mediated-like transport of TTR by the endothelium of the choriocapillaris is present. This is similar to the processing of heparin-gold by this endothelium.

Cytochemical studies of the vascular endothelium.

Cytochemical methods have been used to examine the vascular endothelium. With hemeproteins and immunocytochemistry, investigators have demonstrated the pathways that blood-borne molecules can take to gain access to the extravascular space (Ghitescu et al. 1986; Milici et al. 1987; Schneeberger and Karnovsky 1971; Simionescu et al. 1975). These same cytochemical methods have also provided evidence that morphologically similar endothelia may have different permeability properties (Hart and Pino 1985b, 1986; Pino 1985; Pino and Essner 1980, 1981). Differences in the location and chemical composition of cell surface moieties have been ascertained with enzyme digestion methods, lectins, and cationic ferritin (De Bruyn and Michelson 1978; Pino 1984c, 1986a, b; Simionescu et al. 1981a). The author hopes that he has provided the reader with representative examples of how investigators have used these cytochemical methods for their studies. As new methods are developed and applications are found for existing techniques such as ultracryomicrotomy (Milici et al. 1987) and colloidal gold markers (Pino 1987b), cytochemistry will remain a fundamental tool for the study of the structure and function of the vascular endothelium.

Preparation of retinal vessels for scanning electron microscopic examination using microdissection by ultrasonication.

A method of microdissection by ultrasonication was used to prepare blood vessels of the retina for scanning electron microscopic examination. Eye cups were treated with 2% OsO4 that contained 2% CHAPS or 1% saponin (16 hrs.), dehydrated to 100% acetone, sonicated at 80 kHz (40 min.), and further processed by conventional means. This treatment resulted in the separation of the outer and inner retina at the level of blood vessels in the outer plexiform layer. The overall pattern of the blood vessels was maintained. Venules were distinguished from capillaries. This technique may provide information that is not possible to obtain with corrosion casts or trypsin digests.

Binding and endocytosis of heparin-gold conjugates by the fenestrated endothelium of the rat choriocapillaris.

Heparin-gold probes were used to localize regions of heparin binding on the luminal surface of the diaphragmed-fenestrated endothelium of the rat choriocapillaris. Structures of endothelial cells were unlabeled when rats were kept on ice and perfused with solutions at 4 degrees C. When the heparin-gold quantity was doubled, only a few heparin-gold particles marked some diaphragms spanning fenestrae, vesicles and channels, parajunctional regions of the plasmalemma, and coated pits. With solutions at 4 degrees C, but the animals kept at room temperature, all of these structures in the endothelial cells were labeled. This binding was not altered by the perfusion of low levels of unlabeled heparin, but was eliminated following high levels of unlabeled heparin, and by digestion with trypsin and pronase. At 37 degrees C, heparin was localized to the above structures and, in addition, was internalized into coated vesicles, endosomes, and multivesicular bodies, but not other types of lysosomes. Some particles were found in tubules adjacent to the Golgi stacks. Heparin-gold was also transported to the abluminal front of the endothelium by vesicles. A desulfated, non-anticoagulant, fraction of heparin bound to gold was localized to the endothelium in the same manner. These results demonstrate receptors for heparin on the surface of a fenestrated endothelium. Furthermore, they show the pathway of endocytosis and transport of heparin. The possible roles of heparin in the function of the endothelium is discussed.

Perturbation of the blood-retinal barrier after enzyme perfusion. A cytochemical study.

The retina is protected from circulating molecules by a blood-retinal barrier. This is comprised of the impermeable apical-lateral junctions of the retinal pigment epithelium and intraretinal blood vessels lined by endothelia that have impermeable junctions and vesicles that do not transport material from the luminal to abluminal front. This study examined the effect of enzyme digestion upon the restrictive properties of the retinal capillary endothelium. Rats were perfused first with enzymes and then by hemoglobin that was visualized by ultrastructural cytochemical methods. After perfusion of buffer alone or buffers containing neuraminidase or heparinase, the cytochemical reaction product was confined to the capillary lumina and to endothelial cell vesicles facing the luminal front. In contrast, after heparitinase or pronase perfusion, reaction product filled the extravascular spaces. Chains of endothelial cell vesicles and patent transendothelial channels were often encountered. Endothelial cell junctions did not appear to be affected by enzyme treatment. These findings indicate that a cell-surface heparan sulfate proteoglycan (or a nonidentified protein removed by proteolysis) is a key molecule required for the maintenance of the blood-retinal barrier.

Biogenesis of very-low-density lipoproteins in rat liver. Intracellular distribution of apolipoprotein B.

The hepatic subcellular distribution of apolipoprotein B (apo B) was studied quantitatively by using an enzyme immunoassay developed for apo B and by immunoadsorption-precipitation of [3H]leucine-labelled apo B. Over 50% (of 0.59 microgram/mg protein) of the apo B was located in the microsomal fraction. Further subfractionation of the microsomes revealed that 47% of the microsomal apo B was in the Golgi apparatus, while another 43% was associated with the rough endoplasmic reticulum. The smooth endoplasmic reticulum accounted for only 4% of the total. When rat livers were labelled with [3H]leucine for 10 min, the rough endoplasmic reticulum accounted for 80% of the total immunoadsorbed precipitable apo B radioactivity while the smooth accounted for 20%, with no contribution from the Golgi. However, only 8.7% of the total radioactive immunoadsorbed precipitable apo B was lipoprotein-associated, the remainder being membrane-bound. Lipoprotein-associated apo B radioactivity in the smooth endoplasmic reticulum accounted for 40%, with the rough contribution attributed at 50% and the Golgi at 9%. We concluded that (a) there are two major pools of apo B in rat liver microsomes; (b) although the apo B mass may be negligible in the smooth endoplasmic reticulum, the latter does play a role in lipoprotein biogenesis. The possible function of apo B associated with membranes of the microsomes is also discussed.

Restriction of exogenous transthyretin (prealbumin) by the endothelium of the rat choriocapillaris.

The endothelium of the choriocapillaris has been shown to restrict molecules with Einstein-Stokes radii greater than or equal to 3.2 nm which correspond to minimal molecular weights of approximately 64,000-68,000 daltons. The present study was undertaken to determine if the endothelium restricts exogenous transthyretin (prealbumin), a 55,000-dalton carrier of retinol-binding protein. Rats were injected with human 125I-transthyretin which was allowed to circulate for 15 and 30 min. Chromatographic analysis demonstrated that the human transthyretin did not bind to rat blood proteins. Eye tissue from injected rats was prepared for light and ultrastructural autoradiographic analysis. Autoradiographic grains were confined to areas over the lumen of the choriocapillaris with few present on Bruch's membrane, the basement membrane common to the endothelium of the choriocapillaris and the retinal pigment epithelium. These findings demonstrate that the choriocapillaris can restrict transthyretin and suggest a possible role of its endothelium in the metabolism of retinol-carrier molecules.

Identification of lectin-receptor monosaccharides on the endothelium of retinal capillaries.

The carbohydrate moieties of the glycocalyx of the retinal capillary endothelium were demonstrated using lectin-affinity cytochemistry. The endothelial surface was rich in sialic acid, N-acetylglucosamine, galactose and mannose. Low levels of N-acetylgalactosamine were present. There was no preferential distribution of lectin-receptor monosaccharides on the cell surface. The binding of all lectins was inhibited by the appropriate hapten sugars and by perfusion of trypsin or pronase prior to labeling. No differences were observed between vessels in the inner and outer retina.

Immunocytochemical localization of fibronectin to the retinal pigment epithelium of the rat.

Fibronectin is an anionic asialoglycoprotein that is found on a variety of cell types. This study was undertaken in an attempt to localize fibronectin to the rat retinal pigment epithelium with ultrastructural immunocytochemistry. Using Fab-HRP conjugates specific for fibronectin, reaction product was localized on the surface of the apical processes and within the cell to GERL. After treatment of tissue by the biotin-avidin method employing ferritin-avidin, ferritin particles marked the apical processes in a quasi-regular distribution. Tufts of particles were separated by a linear distance of 65-85 nm. Fibronectin was not localized to rod outer segments.

Pseudoislet vascularization. Induction of diaphragm-fenestrated endothelia from the hepatic sinusoids.

The avascular islet tissue preparation, the pseudoislet, was transplanted into the liver of streptozotocin diabetic rats. The vascularization of the islet tissue was studied ultrastructurally over a 2-week period. At 2 days, proliferations of fibroblast-like cells and large amounts of collagen fibers were present at the periphery of grafts. By 7 days, vascular buds were present at the edge of the graft and invaginating into the islet tissue. At this time, diaphragmed fenestrae were present in the endothelial cells of these forming vessels and they were surrounded by a thin continuous basal lamina. By 12 to 14 days, vascularization was complete as determined by the presence of perfused vessels. At this time the mural architecture of the capillary endothelium was identical to that found in pancreatic islets in situ, i.e., diaphragmed fenestrae, transendothelial channels, and a continuous basal lamina. This contrasted sharply with normal hepatic sinusoidal endothelium which has larger open fenestrae, no channels, and a discontinuous or absent basal lamina. In animals that had been labeled with colloidal carbon before pseudoislet transplantation, the fenestrated endothelium in the grafts contained carbon-filled phagocytic vacuoles indicating the hepatic origin of these cells. Also present at this time was a change in the hepatic sinusoids near the graft sites to a near continuous endothelium. This study demonstrates that isolated avascular adult islet cells are capable of inducing a diaphragm-fenestrated endothelium.

The cell surface of a restrictive fenestrated endothelium. II. Dynamics of cationic ferritin binding and the identification of heparin and heparan sulfate domains on the choriocapillaris.

The location and chemical composition of anionic sites on the endothelium of the choriocapillaris was investigated with cationic ferritin and enzyme digestion techniques. Cationic ferritin administered intravenously initially labeled essentially all fenestral diaphragms. Within 30 min after injection, no diaphragms remained labeled, but they could be relabeled by a second cationic ferritin injection. Following perfusion of cationic ferritin, the entire luminal front of the endothelium was labeled: the plasmalemma and fenestral, vesicle, and channel diaphragms. Perfusion of neuraminidase or chondroitinase did not affect subsequent cationic ferritin binding. In contrast, heparitinase removed anionic sites on all structures except fenestral diaphragms. Cationic ferritin did not mark the endothelium following heparinase digestion. All sites were cleaved with pronase E. These results indicate that heparin is the anionic moiety on fenestral diaphragms while the glycocalices of the plasmalemma and vesicle and channel diaphragms are rich in a heparan sulfate proteoglycan. Furthermore, since the heparan sulfate localized to these structures was digested by both heparinase and heparitinase, it is in a form similar to heparin. These findings demonstrate that the endothelium of the choriocapillaris bears cell-surface anionic components that are different than those described for fenestrated endothelia lining other vascular beds.

The cell surface of a restrictive fenestrated endothelium. I. Distribution of lectin-receptor monosaccharides on the choriocapillaris.

The choriocapillaris is one example of a capillary bed lined by a fenestrated endothelium that is restrictive to exogenous tracers and endogenous plasma proteins. In this study we have examined the distribution of cell-surface monosaccharides utilizing biotinylated lectin-avidin ferritin cytochemistry. Receptors for wheat germ agglutinin were localized to the plasmalemma and diaphragms of some fenestrae, vesicles, and channels at the luminal endothelial front in amounts greater than seen for the other lectins employed. The absence of labeling following inhibition with N-acetylglucosamine and after tissue digestion with N-acetylhexosaminidase, but not after neuraminidase indicated that this lectin marked N-acetylglucosamine residues and not sialic acid. Wheat germ agglutinin receptors were not affected by pronase E or trypsin digestion, but were partially removed by proteinase K. The latter also removed many fenestral diaphragms. Wheat germ agglutinin receptors were cleaved with endoglycosidase D. The combined results indicate that the wheat germ agglutinin receptor is of the low-mannose type and part of a protein with hydrophobic properties. Receptors for concanavalin A (mannose) and Ricinus communis agglutinin (galactose) were also localized to the plasmalemma and endothelial diaphragms. The examination of sections at different tilt angles revealed that these lectins bound to the endothelium in a non-random distribution, encircling diaphragms of fenestrae and channels. Soybean agglutinin (N-acetylgalactosamine) marked endothelial structures sparsely. Following digestion with pronase E or trypsin, receptor sugars for the latter three lectins were completely removed, indicating their presence on protease susceptible glycoproteins. These findings demonstrate that the endothelium of the choriocapillaris bears carbohydrate moieties that are different than those described for permeable fenestrated endothelia.

Capillary permeability in the pancreas and colon: restriction of exogenous and endogenous molecules by fenestrated endothelia.

The permeability properties of fenestrated capillaries in the colon and exocrine and endocrine pancreas to exogenous and endogenous molecules were examined. The exogenous tracers horseradish peroxidase (Einstein-Stokes radius [ESR], 3.0 nm), hemoglobin (ESR, 3.2 nm), and ferritin (ESR, 6.1 nm) were injected intravenously and allowed to circulate for 5-90 min. Tissues were removed and processed for cytochemical or standard electron microscopic examination. The endogenous plasma proteins albumin (ESR, 3.5 nm) and IgG (ESR, 5.5 nm) were localized by immunocytochemistry using the protein A-gold technique. All vessels examined were permeable to HRP in less than 5 min. In contrast, these vessels were restrictive to the slightly larger hemoglobin molecule (60-min circulation) and to ferritin (90-min circulation). Capillaries in the exocrine and endocrine pancreas were restrictive to albumin and IgG. These results demonstrate the presence of fenestrated capillary beds, in addition to the choriocapillaris, that are restrictive to molecules with ESR greater than or equal to 3.2 nm. Capillaries in the mucosa of the colon were restrictive to hemoglobin and ferritin but did not restrict albumin or IgG. This indicates that these vessels are of the permeable type. However, the rate of transendothelial movement of molecules is slower than that of other permeable vessels, such as in the ileo-jejunum. This study has provided further evidence for the existence of fenestrated endothelia that are restrictive to exogenous and/or endogenous molecules.

A comparison of two catalase preparations used to examine vascular permeability.

Beef liver catalase has been used as a tracer in cytochemical studies of vascular permeability. The use of Sigma catalase C-40 and C-100 preparations in capillary permeability studies of the ileojejunum and choriocapillaris was examined. Catalase C-40 is restricted by the fenestrated capillaries of the ileojejunum in contrast to their permeability to C-100. The choriocapillaris restricts both catalase preparations. Sephadex G-200 chromatography of plasma samples incubated with catalase C-40, or from C-40-injected animals, demonstrated an increase in the molecular weight of the tracer. No increase in molecular weight was evident for catalase C-100. The isoelectric point of both preparations was 5.4-5.7. These findings indicate that Sigma catalase C-100 is the preferred preparation for use in vascular permeability studies.

Restriction to endogenous plasma proteins by a fenestrated capillary endothelium: an ultrastructural immunocytochemical study of the choriocapillary endothelium.

The choriocapillaris is a fenestrated capillary bed in the eye that restricts the egress of exogenous tracer molecules with Einstein-Stokes radii (ESR) greater than or equal to 3.2 nm. The present study examined the permeability of its endothelium to the endogenous plasma proteins albumin (ESR, 3.5 nm) and IgG (ESR, 5.5 nm) using ultrastructural immunocytochemistry. Reaction product indicative of the localization of albumin and IgG (using Fab-HRP conjugates) was high in the capillary lumen. In contrast, neither protein was localized extravascularly in Bruch's membrane, in endothelial vesicles, or in endothelial channels. The restriction was evident at the luminal side of the diaphragms spanning fenestrae, vesicles, and channels, and at the luminal front of cell junctions. In marked comparison, high levels of reaction product were localized in the extravascular space surrounding mucosal capillaries in the ileo-jejunum. Observations of tissue subjected to postembedment staining using a protein A-gold method were similar. These findings demonstrate for the first time the restriction of endogenous plasma proteins by a capillary endothelium identical in morphology to that of other vascular beds proven to be permeable.

Binding of Fab-horseradish peroxidase conjugates by charge and not by immunospecificity.

The influence of horseradish peroxidase (HRP) charge on Fab-HRP conjugates was investigated. Rabbit nonimmune Fab coupled via periodate or glutaraldehyde to Sigma HRP type VI (pI greater than 10) were cationic (positively charged) as determined by analytical isoelectric focusing. These conjugates and HRP type VI alone stippled the basal laminae and collagen fibers in Bruch's membrane of the rat eye in a pattern identical to anionic (negative) sites. Binding was not present after the anionic sites were removed by enzyme digestion prior to immunolabeling or when HRP type VIII (anionic with pI 3.6) was used in an Fab-HRP conjugate or in an unbound form. These results indicate that anionic HRPs should be used in Fab-HRP preparations if a nonspecific binding to anionic sites is possible.

Variations in capillary permeability from apex and crypt in the villus of the ileo-jejunum.

The permeability of fenestrated capillaries in an organ is believed to be homogeneous. However, the permeability of fenestrated capillaries in different organs and to various exogenous tracers varies from a complete restriction, as found in the eye (Pino and Essner 1980, 1981; Pino 1985a) to the freely permeable peritubular capillaries of the kidney (Venkatachalam and Karnovsky 1972). In the present report we demonstrate that within any single intestinal villus from the ileo-jejunum of the rat, the permeability of fenestrated capillaries is not uniform. Exogenous hemoglobin (Einstein-Stokes radius [ESR] = 3.2 nm) exists all capillaries at any villar level in less than 5 min. In contrast, all villar capillaries restrict catalase (ESR = 5.2 nm) at 5 min, but by 60 min the tracer is present extravascularly in crypt and lower villar regions. Apical capillaries are slightly permeable to catalase at 2 h, but the bulk of the tracer remains in the lumina. The particulate tracer ferritin (ESR = 6.1 nm) is restricted 3-10 times more by apical capillaries than basal ones and is found in increasing concentration extravascularly at lower villar and crypt levels after 20 min. Following an 18-h circulation, a second dosage of ferritin is restricted by the endothelium at all villar levels. Immunocytochemical localizations of the plasma proteins albumin (ESR = 3.5 nm) and IgG (ESR = 5.5 nm) revealed an apparent lack of restriction at all villar levels. These results demonstrate that apical villar capillaries in the ileo-jejunum are more restrictive to exogenous molecules with ESR greater than or equal to 5.2 nm. Also, the passage of tracer molecules out of an endothelium alters the subsequent permeability of that vessel.