Analysis of polarization and orientation of human polymorphonuclear leukocytes by computer-interfaced video microscopy.

Chemotactic behavior is a complex cellular response to chemical environmental stimuli. For polymorphonuclear leukocytes (PMNs), such behavior involves net migration as well as changes in cell shape and cell orientation. Accordingly, we have applied computer-interfaced video microscopy to analyze cell shape and orientation in control and patient PMNs migrating under agarose. From a digitized tracing of the PMNs at the leading front of migration, cells were characterized in terms of area, circumference, and longest dimension. A shape factor and angle of orientation were computed. Numerical shape factors discriminated three PMN morphologies: polar, apolar, and hyperpolar. Only polar cells could be oriented. Orientation of polar cells was defined as toward, away, or disoriented with respect to the chemotactic gradient. Apolar cells were considered to be nonoriented. Of PMNs from healthy controls, 30 +/- 5% of the cells were oriented toward and 11 +/- 4% of the cells were oriented away from the gradient. For PMNs from patients with localized juvenile periodontitis, a 40% deficit in net migration was associated with reduced orientation toward (5 +/- 2%) and elevated orientation away from the gradient (33 +/- 9%). PMNs from a panel of patients with thermal injury showed reduced migration and orientation toward the gradient associated with elevated percentages of apolar cells. Such analysis of PMN polarization and orientation of the leading front permitted calculation of a chemotactic behavior index. Application of this multiparameter index to the analysis of the chemotactic response may identify PMNs that are defective, but not by evaluation of any single variable.

Efficacy and safety of vitamin D3 intake exceeding the lowest observed adverse effect level.

BACKGROUND: The Food and Nutrition Board of the National Academy of Sciences states that 95 microg vitamin D/d is the lowest observed adverse effect level (LOAEL). OBJECTIVE: Our objective was to assess the efficacy and safety of prolonged vitamin D3 intakes of 25 and 100 microg (1000 and 4000 IU)/d. Efficacy was based on the lowest serum 25-hydroxyvitamin D [25(OH)D] concentration achieved by subjects taking vitamin D3; potential toxicity was monitored by measuring serum calcium concentrations and by calculating urinary calcium-creatinine ratios. DESIGN: Healthy men and women (n = 61) aged 41 +/- 9 y (mean +/- SD) were randomly assigned to receive either 25 or 100 microg vitamin D3/d for 2-5 mo, starting between January and February. Serum 25(OH)D was measured by radioimmunoassay. RESULTS: Baseline serum 25(OH)D was 40.7 +/- 15.4 nmol/L (mean +/- SD). From 3 mo on, serum 25(OH)D plateaued at 68.7 +/- 16.9 nmol/L in the 25-microg/d group and at 96.4 +/- 14.6 nmol/L in the 100-microg/d group. Summertime serum 25(OH)D concentrations in 25 comparable subjects not taking vitamin D3 were 46.7 +/- 17.8 nmol/L. The minimum and maximum plateau serum 25(OH)D concentrations in subjects taking 25 and 100 microg vitamin D3/d were 40 and 100 nmol/L and 69 and 125 nmol/L, respectively. Serum calcium and urinary calcium excretion did not change significantly at either dosage during the study. CONCLUSIONS: The 100-microg/d dosage of vitamin D3 effectively increased 25(OH)D to high-normal concentrations in practically all adults and serum 25(OH)D remained within the physiologic range; therefore, we consider 100 microg vitamin D3/d to be a safe intake.

Concurrent estimation of the kinetics of adhesion and ingestion of Staphylococcus aureus by human polymorphonuclear leukocytes (PMNs).

Direct recording of the kinetics of early phagocytic events, recognition or adhesion and ingestion, may better characterize some forms of polymorphonuclear leukocyte (PMN) dysfunction. This report describes a method and criteria to discriminate concurrently between adhesion and ingestion of Staphylococcus aureus by human PMNs at the level of the light microscope. The criteria were confirmed by several lines of direct evidence: low temperature and cytochalasin b treatment of PMNs; lysostaphin digestion of target Staphylococcus aureus after PMN incubation; and differential ingestibility of colony types I and III N. gonorrheae. Concurrent determinations of the initial kinetics of adhesion and ingestion of bacteria by PMNs demonstrated generalized first order kinetics, sensitive to bacterial challenge ratio and total particle density. Most importantly, the method may be applied to determine if phagocytically defective PMNs actually fail to recognize opsonized bacteria.

Evaluation of 25 OH Vitamin D in chronic renal failure and end stage renal disease subjects.

Analysis of laboratory samples from chronic renal failure (CRF) and end stage renal disease (ESRD) patients can be problematic. Current HPLC and RIA methods for the determination of 25 OH Vitamin D involve sample extraction. However, the differences between a normal and CRF or ESRD matrix can lead to interference or inaccuracy in non-extracted, automated methods now available. The objective of this study was to assess the accuracy of the non-extracted LIAISON 25 OH Vitamin D assay in the analysis of CRF and ESRD samples as compared against RIA as reference. Samples were collected from regional reference laboratories and analyzed in both the LIAISON 25 OH Vitamin D assay and the DiaSorin 25 OH Vitamin D RIA. By Student's t test, no significant difference was observed between the RIA values and the LIAISON values (P = 0.07 CRF; P = 0.28 ESRD). The linear regression analysis resulted in the equations: CRF: LIAISON = 0.91 (RIA) + 0.6; r = 0.82 and ESRD: LIAISON = 0.93 (RIA) - 0.6; r = 0.78. From these data we conclude that the LIAISON 25 OH Vitamin D assay correctly assesses the 25 OH Vitamin D status of CRF and ESRD patients.

Hypovitaminosis D in a normal, apparently healthy urban European population.

Serum 25 OH Vitamin D (25 OH D) concentrations generally vary with latitude, season, and the composition of the population studied. There is a growing recognition that rather than a seasonal specific decline in serum 25 OH Vitamin D, a significant proportion of the population may exhibit asymtomatic subclinical Vitamin D insufficiency. Vitamin D insufficiency has been described in populations at risk, such as nursing home residents and the homebound elderly. We assessed a population of normal, apparently healthy volunteers at a single European urban center for 25 OH Vitamin D sufficiency. Serum 25 OH D concentrations were determined using an automated LIAISON((R)) 25 OH Vitamin D assay. For the purposes of this study, Vitamin D insufficiency was defined as a serum 25 OH Vitamin D concentration of <15 ng/mL. Of the total population (n = 126) 34% exhibited 25 OH Vitamin D concentrations of <15 ng/ml. The mean +/- S.D. serum 25 OH Vitamin D concentration among the total, sufficient, and insufficient populations was 19.4 +/- 7.7, 23.6 +/- 6.4, and 12.1 +/- 2.3 ng/mL. From these data, we conclude that 25 OH Vitamin D insufficiency is more common than previously thought, and is not restricted to high-risk groups.

Nicotine-induced release of elastase and eicosanoids by human neutrophils.

We examined the direct effects of nicotine on a variety of neutrophil functions at concentrations achievable in lung and oral tissues from cigarette smoking. The results show dose-dependent suppression of chemotaxis and phagocytosis, and enhancement of degranulation and eicosanoid generation, but not superoxide production. Cell viability was not affected by the concentrations of nicotine used in these experiments, as shown by trypan blue dye exclusion and MTT assays. These results implicate nicotine as the ingredient in cigarette smoke responsible for inflammatory damage to lungs and oral tissues observed in cigarette smokers.

Refractory periodontitis associated with abnormal polymorphonuclear leukocyte phagocytosis and cigarette smoking.

To learn if refractory periodontitis may be associated with defects in peripheral blood polymorphonuclear leukocyte (PMN) function, phagocytosis and chemotaxis were analyzed in 31 otherwise healthy patients and 12 unaffected controls. When compared to controls, no chemotactic defects to 10 nM f-Met-Leu-Phe (fMLP) were detected. In contrast, phagocytosis was significantly impaired (P < 0.001). The mean rates of adhesion and ingestion of opsonized Staphylococcus aureus by PMNs were 7.1 +/- 1.7 (+/- SD) and 1.4 +/- 0.5 bacteria/100 PMNs/minute respectively for patients, and 11.0 +/- 2.4 and 3.1 +/- 0.6 for unaffected, healthy controls. While the quality of oral hygiene and access to dental care were high, a retrospective search for associated environmental variables showed that 90% (28 of 31) of the refractory patients were smokers. The frequency of smokers is particularly striking, since only 21% of adults in Minnesota use tobacco regularly. These data suggest that there is a strong association between a peripheral blood PMN defect and refractory periodontitis. Furthermore, these studies suggest that tobacco use may contribute to this association.

Involvement of alpha 2-adrenoreceptors and G proteins in the modulation of platelet secretion in response to Streptococcus sanguis.

In the presence of plasma, human platelets secrete the contents of their dense granules and then aggregate in response to certain strains of Streptococcus sanguis. After 2 to 5 min of incubation with streptococci, platelets from fast-responding donors will begin to aggregate. Slow responders aggregate after a longer delay. Platelets may secrete after a short (fast responder) or long (slow responder) delay because of differences in the basal levels or responses to potentiating catecholamines. To test this hypothesis in vitro, endogenous basal catecholamine levels in platelets and plasma from fast and slow responders were analyzed by HPLC with electrochemical detection. The total basal concentration of epinephrine in platelets plus plasma was fourfold higher in fast responders, with the platelet compartment showing the greatest difference. The basal affinity of alpha 2-adrenoreceptors in platelets from both groups was similar when estimated using a specific antagonist, [3H]-yohimbine. Platelets from all donors showed decreased alpha 2-adrenoreceptor affinity in the presence of low (2 nM), but not higher (10 nM), concentrations of added epinephrine. Platelets in the two groups were then compared for secretion of ATP. More ATP was secreted after a shorter delay from fast responding platelets, which was mimicked in slow responders by adding physiologically attainable levels (40 nM) of epinephrine. Addition of the alpha 2-antagonist, phentolamine (10 microM), to the platelets of slow and fast responders completely inhibited or reduced secretion by one third, respectively. Therefore, alpha 2-adrenoreceptors modulate the secretory response of platelets to cells of S. sanguis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Relationship between serum antibody to Bacteroides gingivalis and clinical parameters in periodontitis patients].

Prevalence and proportion of black-pigmented Bacteroides species (BPB) in supragingival and subgingival plaque were determined in ten adult periodontitis patients. Serum antibody against Bacteroides gingivalis (Bg) of these patients were tested using ELISA. Clinical parameters (PI, GI, PD, AL) were collected prior to blood withdrawn. Results showed that BPB were detected in all patients. Mean serum anti-Bg IgG level was significantly greater in the patient group than that in healthy control group. Although the sample size was too small to show statistical difference, there was a trend showing the sera anti-Bg IgG level tended to be greater in accordance with the increase of disease severity and BPB%.

Evidence for an ecto-ATPase on the cell wall of Streptococcus sanguis.

Certain strains of viridans streptococci bind platelets, which release ATP from dense granules and then aggregate. By hydrolyzing the released ATP to the platelet agonist, ADP, cell wall-associated ATPase activity of Streptococcus sanguis may amplify the aggregation of platelets. To identify and characterize this ecto-ATPase activity, whole cells were incubated with [14C]-ATP. The cell-free nucleotides were separated by thin-layer chromatography and quantified by liquid scintillation counting. Whole-cell activity showed temperature and pH optima in the physiological range. To isolate a soluble fraction with ATPase activity from the cell wall, whole cells were digested under osmotically stable conditions to produce protoplasts. Protoplasts and cells were separated from soluble cell wall materials by centrifugation. ATPase activity in cell fractions was identified by zymograms of native 8% polyacrylamide gels after electrophoresis. The ecto-ATPase preparation, membrane and cytoplasmic ATPase in lysed protoplasts showed different zymograms and sensitivity to inhibition by DCCD, ouabain vanadate, azide and NEM. In electron micrographs of ultrathin sections of cells of S. sanguis, ATPase activity was localized to the cell wall. Since the pattern of localization to the wall changed with the phase of growth, the ecto-ATPase of S. sanguis may be associated with the development and maintenance of the cell wall.

Analysis of whole blood tacrolimus concentrations in liver transplant patients exhibiting impaired liver function.

In transplant patients with impaired liver function, HPLC methodologies have been suggested for monitoring whole blood tacrolimus concentrations because of the reported inaccuracy of immunoassay for whole blood tacrolimus concentrations. One hundred fifty whole blood samples from 50 subjects enrolled in a multicenter liver transplant trial were chosen for HPLC/MS/MS analysis without consideration of the clinical status of the patient at the time of sampling. These samples were chosen to represent the sampling intervals during the 12-week posttransplantation period. Retrospectively, the authors identified a subset of 39 samples from 27 subjects exhibiting impaired liver function as demonstrated by bilirubin concentrations > 3.0 mg/dL (mean +/-SD = 7.5 +/- 5.6 mg/dL). The authors compared the agreement of concentrations obtained from the PRO-Trac II ELISA and HPLC/MS/MS by least squares linear regression analysis and Bland/Altman analysis, in this subset against the agreement of concentrations for 76 samples with normal bilirubin. In the samples obtained from patients with impaired liver function the resulting regression equation was: ELISA = 1.19(HPLC) + 0.7; r = 0.9. The mean difference (HPLC/MS/MS - ELISA) was -2.5 ng/mL +/- 2.9 ng/mL (mean +/- SD). While 71% of samples agreed within 3 ng/mL, 3% (n = 1) exhibited a difference >10 ng/ml. The corresponding evaluation of the samples with normal bilirubin concentrations resulted in the regression equation ELISA = 0.96(HPLC) + 0.9; r = 0.9, and a mean difference of -0.6 ng/mL +/- 2.3 ng/mL. The authors conclude that while a small subset of patients with cholestasis may require closer evaluation with a more specific methodology, the majority of the patients may be satisfactorily monitored with the PRO-Trac II ELISA.

The platelet interactivity phenotype of Streptococcus sanguis influences the course of experimental endocarditis.

A strain of Streptococcus sanguis that induced rabbit platelets to aggregate in vitro (Agg+ phenotype) was hypothesized to be a more virulent pathogen than an Agg- strain in experimental endocarditis in rabbits. A left ventricular catheter was implanted, and then an Agg+ or Agg- strain was inoculated intravenously. Vegetations formed on the aortic semilunar valves but were unaffected by the duration of implantation of the catheter. Vegetations enlarged by accumulating platelets and their mass increased directly with the duration of endocarditis. Inoculation of the Agg+ strain consistently caused endocarditis with significantly larger vegetations, a more severe clinical course (including febrile episodes, hematological changes, and signs of myocardial ischemia), more gross lesions in major organs, and greater mortality than inoculation with the Agg- strain, saline, or the Agg+ strain pretreated with monospecific rabbit immunoglobulin G or Fab fragments against its platelet aggregation-associated protein (PAAP; class II). In experimental endocarditis, PAAP expressed by Agg+ S. sanguis appeared to be an important virulence factor.

Analytical validation of the PRO-Trac II ELISA for the determination of tacrolimus (FK506) in whole blood.

BACKGROUND: The analytical validation of multiple lots of the PRO-Trac II ELISA (DiaSorin) for the determination of tacrolimus in whole blood is described. METHODS: The analytical parameters assessed included analytical sensitivity, dilution linearity, functional sensitivity, values in samples containing no tacrolimus, intra- and interassay precision, supplementation and recovery, metabolite cross-reactivity, interference studies, and method comparisons HPLC-tandem mass spectrometry (HPLC/MS/MS) and the IMx Tacrolimus II multiparticle enzyme immunoassay. Where appropriate, assessments were performed according to NCCLS guidelines. RESULTS: The mean analytical detection limit was <0.25 microg/L for all lots, whereas the functional sensitivity was 1.0 microg/L. Excellent linear correlation (r = 0.985) was observed for dilution linearity. The intraassay imprecision was <7%, and the total imprecision by ANOVA was <10%. Recovery was 109% +/- 11%. Metabolite cross-reactivity was consistent with previous reports for this antibody. No interference was observed for 35 tested drugs. Method comparison with HPLC/MS/MS showed no statistically significant differences. Samples exhibited stability through four freeze/thaw cycles and for 1 week at room temperature. CONCLUSION: These data demonstrate that the PRO-Trac II ELISA is a robust, accurate, and precise tool for the assessment and management of tacrolimus blood concentrations in transplant patients.

Therapeutic drug monitoring of tacrolimus in pediatric liver transplant patients.

The clinical utility of tacrolimus monitoring in adults has been well documented. The present study compared tacrolimus monitoring in a pediatric population of 34 liver transplant patients in four US centers with an adult population of 111 patients in six US centers. Subjects (adult and pediatric) were evaluated, at defined intervals over 12 weeks post-transplantation (Tx), for tacrolimus trough concentrations and 12 additional laboratory chemistries. Pediatric patient and graft survival for the 12 weeks were 91% and 88%, respectively, as compared to 97% and 93%, respectively, for the adult population. The mean oral dosage of tacrolimus for pediatric patients was 0.13 +/- 0.1 mg/kg/day at week 1, increased to 0.30 +/- 0.3 mg/kg/day by week 3 and remained constant for the remainder of the study. These dosages were two- to three-fold higher than the dosage used in the adult population. In contrast, the mean whole-blood trough concentration, as determined by PRO-Tractrade mark II enzyme-linked immunosorbent assay (ELISA), decreased from 11.3 +/- 5.1 ng/mL at week 1 to 6.3 +/- 3.7 ng/mL by week 12 and was not significantly different from the trough concentration in adults. The incidence and distribution of the clinical end-points for the pediatric subjects (rejection, nephrotoxicity, death, re-Tx) were different from those observed in adults. The total percentage of pediatric subjects reaching any end-point was 74%, as compared to 54% in the adult population. These data indicate several differences between the adult and pediatric populations in their response to tacrolimus.

Phenotypic characterization of Streptococcus sanguis virulence factors associated with bacterial endocarditis.

Certain strains of Streptococcus sanguis adhere (Adh+) selectively to human platelets and, in plasma, induce them to aggregate (Agg+) into in vitro thrombi. In this study, we examined 18 recent endocarditis and dental plaque isolates of microorganisms that were biotyped as S. sanguis for coexpression of platelet interactivity phenotypes with another possible virulence factor in bacterial endocarditis, dextran synthesis. Detectable production of extracellular glucosyltransferase ranged from 0.2 to 66 mU/mg of culture fluid for 10 representative strains tested. Production of extracellular or cell-associated glucosyltransferase, fructosyltransferase, and soluble or insoluble dextrans was not necessarily coexpressed with platelet interactivity phenotypes, since the levels of production of soluble and insoluble dextrans varied among representative Adh+ Agg+ and Adh- Agg- strains. Analysis of a second panel of 38 fresh dental plaque isolates showed that S. sanguis distributes in a reproducible manner into the possible phenotype groups. Strains with different platelet interactivity phenotypes were distinguished with a panel of four murine monoclonal antibodies (MAbs) raised against Adh+ Agg+ strain 133-79 and screened to rule out artifactual reactions with antigenic components in culture media. The MAbs reacted selectively with Adh+ Agg+ strains in a direct-binding, whole-cell, enzyme-linked immunosorbent assay and also inhibited their interactions with platelets. Analysis of minimal tryptic digests of many strains, including variants that failed to bind the MAbs, suggested that some noninteractivity phenotypes possess cryptic surface determinants. Since the ability to adhere to platelets and induce them to aggregate is relatively stable, these traits may be useful in a phenotyping scheme for these Lancefield nontypeable streptococci.