Discovery of highly potent small molecule kallikrein inhibitors.

Uncontrolled kallikrein activation is involved in diseases such as hereditary angioedema, bacterial septic shock and procedures such as cardiopulmonary bypass. Here we report a series of small molecule compounds that potently inhibit kallikrein activity in vitro. Kinetic studies indicate that some of these compounds are slow binding inhibitors of kallikrein with Ki final less than a nanomolar. The ability of these compounds to inhibit the activity of kallikrein was further confirmed in a plasma model by quantitating the release of bradykinin, an endogenous cleavage product of plasma kallikrein. To understand the inhibitory mechanism of the selected compounds toward kallikrein, the interactions between the selected compounds and kallikrein was explored using molecular modeling based on the information of crystal structures of TF/FVIIa and kallikrein. The information presented in the current study provides an initial approach to develop more selective and therapeutically useful small molecule inhibitors.

Crystallization and preliminary X-ray investigation of factor D of human complement.

Human factor D, an essential enzyme of the alternative pathway of complement activation, has been crystallized. Crystals were grown by vapor diffusion using polyethylene glycol 6000 and NaCl as precipitants. The factor D crystals are triclinic and the space group is P1 with unit cell dimensions a = 40.8 A, b = 64.7 A, c = 40.3 A, alpha = 101.0 degrees, beta = 109.7 degrees, gamma = 74.3 degrees. The unit cell contains two molecules of factor D related by a non-crystallographic 2-fold axis. The crystals grow to dimensions of 0.8 mm x 0.5 mm x 0.2 mm within five days, are stable in the X-ray beam and diffract beyond 2.5 A.

Structures of native and complexed complement factor D: implications of the atypical His57 conformation and self-inhibitory loop in the regulation of specific serine protease activity.

Factor D is a serine protease essential for the activation of the alternative pathway of complement. The structures of native factor D and a complex formed with isatoic anhydride inhibitor were determined at resolution of 2.3 and 1.5 A, respectively, in an isomorphous monoclinic crystal form containing one molecule per asymmetric unit. The native structure was compared with structures determined previously in a triclinic cell containing two molecules with different active site conformations. The current structure shows greater similarity with molecule B in the triclinic cell, suggesting that this may be the dominant factor D conformation in solution. The major conformational differences with molecule A in the triclinic cell are located in four regions, three of which are close to the active site and include some of the residues shown to be critical for factor D catalytic activity. The conformational flexibility associated with these regions is proposed to provide a structural basis for the previously proposed substrate-induced reversible conformational changes in factor D. The high-resolution structure of the factor D/isatoic anhydride complex reveals the binding mode of the mechanism-based inhibitor. The higher specificity towards factor D over trypsin and thrombin is based on hydrophobic interactions between the inhibitor benzyl ring and the aliphatic side-chain of Arg218 that is salt bridged with Asp189 at the bottom of the primary specificity (S1) pocket. Comparison of factor D structural variants with other serine protease structures revealed the presence of a unique "self-inhibitory loop". This loop (214-218) dictates the resting-state conformation of factor D by (1) preventing His57 from adopting active tautomer conformation, (2) preventing the P1 to P3 residues of the substrate from forming anti-parallel beta-sheets with the non-specific substrate binding loop, and (3) blocking the accessibility of Asp189 to the positive1y charged P1 residue of the substrate. The conformational switch from resting-state to active-state can only be induced by the single macromolecular substrate, C3b-bound factor B. This self-inhibitory mechanism is highly correlated with the unique functional properties of factor D, which include high specificity toward factor B, low esterolytic activity toward synthetic substrates, and absence of regulation by zymogen and serpin-like or other natural inhibitors in blood.

Structure of human factor D. A complement system protein at 2.0 A resolution.

Factor D, an essential enzyme for the activation of the alternative pathway of the complement system, belongs to the serine protease superfamily. The crystal structure of the enzyme was solved by a combination of multiple isomorphous replacement and molecular replacement methods. The present model was refined to an R-factor of 18.8% using 23,681 observed reflections between 7.5 and 2.0 A resolution, with a root-mean-square deviation from standard bond lengths of 0.016 A. The two non-crystallographically related molecules in the triclinic unit cell have distinctive active site conformations. The protein has the general structural fold of a serine protease, but there are several unique amino acid substitutions resulting in significant alterations in the critical loops responsible for catalysis and substrate specificity in serine proteases. Factor D is the first complement serine protease whose three-dimensional structure has been determined.

Peripheral blood mononuclear leukocytes release a mediator(s) that induces phagocytosis of C-reactive protein-coated cells by polymorphonuclear leukocytes.

We studied the phagocytosis by human polymorphonuclear leukocytes (PMN) of sheep erythrocytes (E) passively sensitized with pneumococcal C-polysaccharide (E-PnC), E-PnC coated with C-reactive protein (E-PnC-CRP), and E coated with rabbit antisheep E IgG (E-IgG). PMN isolated from the blood of normal individuals failed to ingest either E-PnC or E-PnC-CRP; however, after incubation with supernatants from stimulated peripheral blood mononuclear leukocytes, glass-adherent PMN ingested E-PnC-CRP with a mean phagocytic index of 47.8 +/- 14.9 (means +/- SD, n = 9) and E-PnC to a lesser extent with a phagocytic index of 9.6 +/- 2.9 (mean +/- SD, n = 4). We also observed a statistically significant increase in the ingestion of E-IgG by lymphokine-stimulated PMN with phagocytic indices of 85.2 +/- 21.2 (mean +/- SD, n = 12) for unstimulated PMN and 158 +/- 37.1 (mean +/- SD, n = 9) for stimulated PMN. The best conditions for stimulating release of this phagocytosis-promoting mediator included exposure to phytohemagglutinin (PHA) in the presence of monocytes that had ingested IgG-coated sheep erythrocytes. The induction of phagocytosis of E-PnC-CRP was rapid, reaching a maximal level after stimulation of the adherent PMN with the conditioned media for 30 min. The factor(s) responsible for the induction of the ingestion of E-PnC-CRP was less than 10,000 daltons and was heat stable (56 degrees C for 45 min). These data are similar to earlier results obtained with PMN activated by 12-0-tetradecanoyl-phorbol-13-acetate (PMA), an important contrast being that in the current studies PMN were activated by a soluble factor released from stimulated mononuclear cells under conditions simulating those in vivo.

Demonstration of calcium-induced conformational change(s) in C-reactive protein by using monoclonal antibodies.

Three out of four anti-C-reactive protein monoclonal antibodies [HB3-2, (micro, k)], EA4-1 (gamma 2a, k) and FB2-1 (gamma 1, k) bind to C-reactive protein in the presence of 2.5 mM Ca2+ but not in the presence of 1.0 mM EDTA, indicating that the conformation of the antigenic determinant(s) recognized by these three antibodies is dependent upon Ca2+. This Ca2+-dependent binding can be inhibited by 1.0 mM phosphocholine, indicating that this antigenic determinant is at or near the phosphocholine-binding site of C-reactive protein. The binding of the fourth monoclonal antibody [HD2-4 (gamma 2-k)] is independent of the presence of Ca2+ and is not inhibited by phosphocholine. HB3-2 (micro, k) recognizes an antigenic determinant on the structurally related proteins, rabbit CRP and serum amyloid P.

Generation of phenotypically distinct macrophage-hepatoma hybrid clones.

By fusion of C3H/HeJ splenic adherent mononuclear cells enriched for macrophages with HPRT-deficient C57L/J HH- hepatoma cells, we have generated six macrophage-hepatoma hybrid clones. The hybrid nature of isolated clones was demonstrated by karyotypic analysis. The hybrid clones were screened for macrophage properties by assaying the presence of two enzymes: nonspecific esterase and lysozyme. Three of six hybrids expressed higher amount of Ia antigen and less amount of FcR; the other three hybrids expressed higher amounts of Fcr, but no Ia antigen. Phagocytosis of serum-opsonized beads is positively correlated with FcR expression, while the proliferation of antigen-primed lymphocytes is only induced by antigen-pulsed hybrids expressing Ia antigen. One hybrid clone (MH3-1) secreted significantly higher level of PGE2 and also expressed Ia antigen with higher ability of antigen-presentation. The data suggest that the cell hybridization can segregate macrophage-featured phenotypes into different hybrid clones which perform distinct functions. It may facilitate the study on the relationship of macrophage functions and the relationship between the functions and defined cell structure.

Purine nucleoside phosphorylase inhibitor BCX-1777 (Immucillin-H)--a novel potent and orally active immunosuppressive agent.

Patients with purine nucleoside phosphorylase (PNP) deficiency present a selective T-cell immunodeficiency. Inhibitors of PNP are, therefore, of interest as potential T-cell selective immunosuppressive agents. BCX-1777 is a potent inhibitor of PNP from various species including human, mouse, rat, monkey and dog, with IC50 values ranging from 0.48 to 1.57 nM. BCX-1777, in the presence of 2'-deoxyguanosine (dGuo, 3-10 microM), inhibits human lymphocyte proliferation activated by various agents such as interleukin-2 (IL-2), mixed lymphocyte reaction (MLR) and phytohemagglutinin (PHA) (IC50 values < 0.1-0.38 microM). BCX-1777 is a 10-100-fold more potent inhibitor of human lymphocyte proliferation than other known PNP inhibitors like PD141955 and BCX-34. Nucleotide analysis of human lymphocytes indicate that inhibition of proliferation by BCX-1777 correlates with dGTP levels in the cells. BCX-1777 has excellent oral bioavailability (63%) in mice. At a single dose of 10 mg/kg in mice, BCX-1777 elevates dGuo to approximately 5 microM. BCX-1777 was not effective in mouse T-cell models such as delayed type hypersensitivity (DTH) and splenomegaly because mouse T-cells do not accumulate dGTP as do human T-cells. However, in the human peripheral blood lymphocyte severe combined immunodeficiency (hu-PBL-SCID) mouse model, BCX-1777 was effective in prolonging the life span 2-fold or more. This is the first known example of a PNP inhibitor that elevates dGuo in mice similar to the levels observed in PNP-deficient patients. Furthermore, these dGuo levels are also required for in vitro T-cell inhibition by BCX-1777. Thus, BCX-1777 represents a novel class of selective immunosuppressive agents that could have therapeutic utility in various T-cell disorders.

Treatment of acute serum sickness by plasma ultrafiltration.

The clinical value of a scaled-down prototype of an extracorporeal plasma ultrafiltration system for the treatment of acute serum sickness in rabbits was examined. The system uses two filters: the primary separates red cells from plasma, and the secondary filter excludes high molecular weight proteins from plasma. In vitro and in vivo experiments showed that the secondary filters rejected substantially more IgM (80-90%) than IgG (10-30%) or albumin (10%) and totally rejected immune complexes (IC) prepared in vitro. Two groups of rabbits were submitted to either sham filtration with the primary filter only (n = 5), receiving back the remixed components of their blood, or to the complete ultrafiltration protocol (n = 7), with removal of high molecular weight proteins and IC. Several parameters were studied longitudinally, such as circulating IC, which appeared to rise more slowly in animals whose blood was ultrafiltered, and total proteinuria, which appeared to remain at lower levels in the same animals. Histologic examination of the kidneys, collected after killing, showed evidence of glomerular IC deposition in three of five sham-treated animals (a similar frequency to that observed in a separate group of five rabbits with acute serum sickness), while one of six treated animals had evidence of glomerular deposition of IC. These observations are tentative because of the small number of animals in each group, but are encouraging. Further studies with larger groups of animals are needed to determine whether the observed effects are reproducible and to better characterize the factors directly related to the removal of circulating IC.

Statistical analysis of five immune complex screening assays: patterns of detection in patients with rheumatoid arthritis, systemic lupus erythematosus, infectious endocarditis, and diabetes mellitus.

A comparative study of four nonspecific screening techniques (direct nephelometry, PEG-C4, PEG-IgG, and radiolabeled Clq binding) for immune complexes (IC) and of a technique specific for the detection of insulin-anti-insulin IC was undertaken in four groups of patients with diagnosis of infectious endocarditis, systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and diabetes. The highest frequency of positive results was given by the PEG-IgG test in RA, the Clq-binding test in SLE, the insulin-anti-insulin IC screening test in diabetes, and the PEG-IgG and Clq-binding tests in infectious endocarditis. Of the four nonspecific tests, the PEG-C4 assay appeared to be the least discriminative, since it failed to show significant differences between any group of patients and the group of controls. Direct nephelometry, PEG-IgG, and radiolabeled Clq binding gave consistently higher results in RA than in other diseases, and in this disease the rates of agreement between these tests were highly significant. Significant agreements between the rates of positivity of Clq binding and PEG-IgG tests were seen in all groups of patients studied. Spearman's analysis of rank showed the best correlations among tests based on similar principles (ie, PEG precipitation), and also a strong correlation between Clq binding and the PEG-IgG test in RA. The PEG-IgG test appears to be a reliable IC screening test for general use with the advantage of not involving radioisotopes. In regard to antigen-specific tests, although their specificity and sensitivity may be high, their results may show no correlation with nonspecific screening tests nor with the presence or absence of clinical or laboratory abnormalities suggestive of IC deposition, as exemplified by the insulin-anti-insulin IC screening test in diabetic patients.

Development of a single numerical expression for the results of multiple screening tests for immune complexes in diabetic patients: use in statistical comparison of clinically and biochemically defined patient populations.

A series of 88 diabetic patients were studied for the presence of soluble immune complexes, proteinuria, microangiopathy, and diabetic complications. Results of the five different assays for immune complexes were analyzed individually, and four combinations of the individual results (i.e. four different immune complex "scores") were also analyzed. The only assay which consistently discriminated between the different patient groups was the PEG-IgG test, in which a ratio between the amount of IgG precipitated with 3% PEG 6000 and the serum concentration of IgG is determined. In contrast, all four of the immune complex "scores" detected significant differences between patients with and without the clinical or biochemical parameter in question. One combination, designated as the "weighted and corrected IC score", gave a particularly high probability of detecting differences between groups. These results indicate that proper compilation of the results of a battery of immune complex screening assays can provide definite advantages over the results of individual tests for the investigation of correlations between the presence of soluble immune complexes and the course and pathology of various diseases.

The role of circulating immune complexes in the pathogenesis of diabetes mellitus.

We have studied soluble immune complexes (IC) in the sera of both insulin-dependent and non-insulin-dependent diabetics by a variety of non-specific techniques and also by a method that detects specifically insulin-anti-insulin IC. Our screening studies, detailed in the first section of this work, showed that insulin-anti-insulin IC appear not to be the only type of IC present in diabetics. Non-specific screening tests gave practically identical percentages of positive results in insulin-dependent and non-insulin-dependent diabetics. However, the agreement between different screening tests was poor. We propose the use of 'IC scores' (numerical expressions of the general trend of several screening tests performed with one given serum sample) for the statistical analysis of correlations between the presence of soluble IC and clinical evidence of diabetic microangiopathy. As expected, the use of 'scores' minimized false positive or negatives and considerably enhanced statistical correlations between levels of IC and proteinuria, nephropathy, retinopathy, peripheral neuropathy, and peripheral vasculopathy. The second section of this report describes our isolation studies, which provided definitive proof for the existence of soluble insulin-anti-insulin IC and allowed us to carry out the first successful studies of the biological properties of soluble IC purified from the sera of diabetic patients, as detailed in the third section of this report. Such IC-induced platelet aggregation and activation which in vivo could lead to the development of microvascular lesions could explain, at least in part, the abnormalities in platelet function seen in diabetics. Although the precise mechanisms by which soluble IC could induce pathological damage in diabetics have not been totally clarified, we have obtained sufficient evidence to prove that antigen-antibody complexes exist in diabetics, are associated with higher frequencies of complications, and have the capacity to interact with cells in a potentially pathogenic fashion.

Opsonic properties of C-reactive protein. Stimulation by phorbol myristate acetate enables human neutrophils to phagocytize C-reactive protein-coated cells.

We examined phagocytosis of sheep erythrocytes passively sensitized with pneumococcal C-polysaccharide (E-PnC) and of E-PnC coated with C-reactive protein (E-PnC-CRP) by human polymorphonuclear leukocytes (PMN). PMN isolated from blood of normal individuals failed to ingest either E-PnC or E-PnC-CRP; however, after stimulation with 12-O-tetradecanoylphorbol-13-acetate (PMA; 2 ng/ml), PMN ingested E-PnC-CRP efficiently with a mean phagocytic index (PI) of 99.5 +/- 4.8 (mean +/- SD, n = 11), and E-PnC to a lesser extent with a mean PI of 33.2 +/- 11.7 (mean +/- SD, n = 11). PMN that had adhered to PnC-coated glass and that were stimulated with PMA attached but did not ingest E-PnC-CRP. In contrast, PMN plated on E-PnC-CRP-coated glass and stimulated with PMA did not attach or ingest E-PnC-CRP. These data indicate that PMN can be induced to phagocytize PnC-CRP and that both PnC and CRP are required for ingestion. They also suggest that specific receptors for these ligands are expressed by stimulated PMN. Neither attachment nor phagocytosis of E coated with rabbit anti-E IgG (E-IgG) was affected by plating PMN on PnC or PnC-CRP. On the other hand, both phagocytosis and ingestion of E-PnC-CRP as well as E-IgG was blocked by plating PMA-stimulated PMN on immune complexes containing rabbit IgG. Inhibition experiments with the use of 3G8, a monoclonal antibody to the Fc gamma receptor of PMN, and human monomeric IgG1 demonstrated that attachment of E-PnC-CRP is mediated by receptors other than the Fc gamma receptors. These combined results indicated a nonreciprocal association between the putative CRP receptors and the Fc gamma receptors of stimulated PMN, resulting in the clearance of both types of receptors from the apical surface of PMN by antigen-immobilized rabbit IgG.

Inhibition of platelet-activating factor by rabbit C-reactive protein.

Incubation of 0.5 nM platelet-activating factor (PAF) with 123 micrograms/ml C-reactive protein (CRP) for 60 min at room temperature in the presence of 2 mM calcium resulted in total inhibition of the platelet-aggregating capacity of 0.5 nM PAF. There was no inhibition of platelet aggregation if PAF and CRP were added to the platelets simultaneously, without prior incubation of the mixture, or if calcium was not present during the incubation of CRP and PAF. The inhibitory effect of CRP (123 micrograms/ml) was dependent upon the time of incubation with PAF (1 nM). We observed 0, 42, and 85% inhibition of platelet aggregation with incubations of 0, 20, and 120 min, respectively. The inhibitory effect of CRP was also concentration dependent. After incubations of 20 min at room temperature with 0.5 nM PAF there was no inhibition of PAF-induced platelet aggregation using 12.3 micrograms/ml CRP with the inhibition increasing to 73% using 123 micrograms/ml CRP. Pretreatment of the platelets with CRP (123 micrograms/ml) for 60 min before addition of PAF did not affect the induction of platelet aggregation by PAF. These observations indicate that CRP inhibits PAF and strongly suggest that binding of CRP to PAF, presumably to the phosphocholine moiety of PAF, is required for this inhibition.

Human endothelial cell damage induced by interactions between polymorphonuclear leukocytes and immune complex-coated erythrocytes.

We have examined, in vitro, the effects of autologous erythrocytes (RBC) coated with soluble immune complexes (RBC-IC) on the interactions of polymorphonuclear leukocytes (PMN) with human endothelial cell (EC) cultures. RBC-IC were prepared by incubating human RBC with soluble immune complexes, prepared with keyhole limpet hemocyanin (KLH) and rabbit anti-KLH in antigen excess, using normal human serum as a complement source. Several parameters believed to be related to EC-PMN interactions, including adherence of PMN to EC, detachment of EC after incubation with media harvested from RBC-IC-stimulated PMN, and the release of 2-deoxy-D-[3H]glucose from damaged EC, were investigated. The proportion of PMN adhering to EC increased in direct proportion to the number of RBC-IC used to stimulate PMN. Media harvested from PMN stimulated with RBC, RBC incubated with complement, RBC-IC, or opsonized zymosan caused variable degrees of detachment of cultured EC. The percentage of EC detached was directly related to the intensity of the PMN degranulation as measured by lysozyme release with a correlation coefficient of 0.935, comparing the natural log of the lysozyme released to the percentage EC detachment. Finally, RBC-IC added to PMN and EC induced PMN-mediated EC damage as measured by the release of 2-deoxy-D-[3H]glucose from the labeled EC. The release of 2-deoxy-D-[3H]glucose from the labeled EC was directly related to the number of RBC-IC used to stimulate the PMN. These data indicate that RBC-IC are able to stimulate the type of interactions between PMN and EC that are believed to cause EC damage and may play a role in the initiation or exacerbation of inflammatory vascular lesions.

Solid-phase enzymoimmunoassay of antitetanus toxoid antibodies.

A solid-phase enzymoimmunoassay (EIA) for antitetanus toxoid antibodies has been developed using activated agarose beads as the solid phase to which tetanus toxoid was covalently attached. The resulting EIA proved to be remarkably free of interference due to nonspecific absorption of reactants to the solid phase. The lower limit of detection for the assay was 0.008 U/ml of antibody. Reproducibility studies showed a satisfactory degree of consistency with coefficients of variation of 4.8% (within run) and 6.6% (run-to-run). This assay has been applied successfully to the evaluation of the humoral response to tetanus toxoid in both normal and immunocompromised individuals and it has sufficient sensitivity to determine serum levels of antitetanus antibody above the accepted protective limit of 0.01 U/ml.

Depression of humoral responses and phagocytic functions in vivo and in vitro by fish oil and eicosapentanoic acid.

Previous studies have demonstrated that eicosapentanoic acid (EPA) has anti-inflammatory properties in both humans and experimental animals and may also depress humoral immunity in experimental animals. Our investigations showed that the addition of eicosapentanoic acid to human peripheral blood mononuclear cell cultures inhibited B cell responses to mitogenic stimulation and depressed the expression of interleukin 2 receptors in pokeweed mitogen-stimulated lymphocytes. Neutrophils were also affected in their ability to release the contents of primary and secondary granules, particularly when stimulated with antigen-antibody complexes. Similar depressions of B cell responses and neutrophil functions were observed in a normal volunteer who ingested 6 g/day of a commercially available fish oil extract (equivalent to 2.1 g of EPA/day) during a 6-week period. Phagocytosis, enzymatic release, circulating immunoglobulin levels, and the response to tetanus toxoid both in vivo and in vitro were depressed during ingestion of fish oil. Most parameters showed a trend toward normalization 6 weeks after the suspension of fish oil supplementation. These effects of fish oil extracts and EPA on phagocytosis and humoral responses may be advantageously used in the therapy of chronic inflammatory diseases and autoimmune diseases but could be a cause for concern when these compounds are used for longer periods of time and with minimal medical supervision for the prophylaxis of atherosclerosis.