Impaired phagocytic activity of neutrophils in patients receiving haemodialysis: the critical role of iron overload.

The metabolic burst (as measured by the spontaneous and stimulated nitroblue tetrazolium tests), the phagocytosis of heat inactivated bakers'' yeast and of Staphylococcus aureus, the killing of Staph aureus, and the myeloperoxidase activity of polymorphonuclear neutrophils were studied in 11 patients receiving maintenance haemodialysis. Of these patients, six were polytransfused and had high serum ferritin concentrations (mean 5940 (SD 2925) micrograms/l; group 1), and five had normal serum ferritin values (mean 171 (116) micrograms/l; group 2). Patients in group 1 had a history of more infectious episodes (0.167 v 0.025 per patient per month) and significantly more genitourinary infections (p = 0.015) than those in group 2. Phagocytosis and myeloperoxidase activity were severely reduced in group 1 but normal in group 2. Percentages of neutrophils ingesting one or more particles together with the index of phagocytosis in patients'' serum were inversely correlated with serum ferritin concentrations. Four patients in group 1 were treated with desferrioxamine, and after six to 18 weeks of treatment phagocytosis and myeloperoxidase activity had returned to normal in three of them. These data suggest that in patients receiving haemodialysis iron overload due to multiple transfusions plays an important part in the mechanisms underlying the susceptibility to bacterial infections, mediated at least partially through impaired neutrophil function.     

Influence of the degree of saturation of iron stores on the gastrointestinal absorption of aluminum

The possible influence of iron metabolism in the regulation of aluminum gastrointestinal absorption in male Wistar rats has been studied. Three groups were considered: Fe overloaded Group 1; Fe normal Group 2; Fe depleted Group 3. All groups were exposed during 45 days to 40 mg of Al(OH)3 investigating the concentration of Al in serum and urine throughout the experiment and also the Al in brain at the end of that period. Results demonstrated that 24 h urinary Al excretion was significantly higher in Fe depleted rats than in Fe overloaded animals (p less than 0.01 and p less than 0.05 respectively). In addition, Al in brain showed the same pattern of deposition yielding in the Fe depleted rats nearly a three fold increase in the concentration of Al. By contrast, serum Al did not show any particular trend. These findings are in agreement with the fact that Fe metabolism may modulate Al gastrointestinal absorption suggesting that Al and Fe might share the same mechanism of gastrointestinal absorption.     

Biofeedback-assisted relaxation: Effects on phagocytic capacity

The purpose of this study was to investigate whether subjects who self-report high levels of stress have lower immunity, and whether low-immunity subjects under high stress could enhance phagocytic activity through biofeedback-assisted relaxation (BAR). During Phase 1, the level of stress and the level of phagocytic immune functioning (nitroblue tetrazolium test) were assessed as high or low. Significant chi-square analysis (x²=3.8624, df=1, p<.05) showed that subjects with high stress had low immunity. Sixteen high-stress, low-immunity subjects were randomly assigned to BAR and control groups during Phase 2. Following treatment, NBT changes showed significant increases (F=11.11, p<.003) for experimental group as compared to control group. White blood cell count and white blood cell differential were unchanged across blood samples for both groups. Experimental subjects reported significant decreases in tension-anxiety and increases in overall coping. BAR was concluded to have improved coping skills and phagocytic capacity. BAR affected the quality, rather than the quantity, of phagocytic neutrophils.     

Biofeedback-assisted relaxation: effects on phagocytic capacity

The purpose of this study was to investigate whether subjects who self-report high levels of stress have lower immunity, and whether "low"-immunity subjects under "high" stress could enhance phagocytic activity through biofeedback-assisted relaxation (BAR). During Phase 1, the level of stress and the level of phagocytic immune functioning (nitroblue tetrazolium test) were assessed as "high" or "low." Significant chi-square analysis (chi 2 = 3.8624, df = 1, p less than .05) showed that subjects with "high" stress had "low" immunity. Sixteen "high"-stress, "low"-immunity subjects were randomly assigned to BAR and control groups during Phase 2. Following treatment, NBT changes showed significant increases (F = 11.11, p less than .003) for experimental group as compared to control group. White blood cell count and white blood cell differential were unchanged across blood samples for both groups. Experimental subjects reported significant decreases in tension-anxiety and increases in overall coping. BAR was concluded to have improved coping skills and phagocytic capacity. BAR affected the quality, rather than the quantity, of phagocytic neutrophils.     

Study of the phagocytic process in neutrophils from elite sportswomen

All the stages of the phagocytic process of blood neutrophils were compared in sedentary young women (no formal exercise during the previous 24 months) and elite sportswomen (basketball players from the Siglo XXI Spain Selection, in the middle of their competitive season) at rest. The sportswomen had performed no exercise since the day before taking the blood samples. Adherence of neutrophils to nylon fibre, which is similar to endothelium adherence, was not different between the two groups [62 (SD 14) and 58 (SD 18) in control and sport groups respectively]. Chemotaxis (studied in a Boyden chamber using a filter with 3 m pore diameter) was found to be stimulated (P<0.001) in the sportswomen [105 (SD 30)] with respect to the controls [39 (SD 9)]. Attachment, ingestion and killing by neutrophils was measured by incubation of the neutrophils with serum and a suspension ofCandida albicans. While no statistical differences were found in attachment ofC. albicans after 15 min incubation [71 (SD 8) in the control group, and 74 (SD 20) in the sport group], the sportswomen showed a higher (P<0.001) ingestion capacity forC. albicans at both 15 min [53 (SD 13) and 111 (SD 32) in control and sportswomen respectively] and 60 min [control 90 (SD 10), and sport group 224 (SD 21)] incubation. The greater phagocytic capacity in sportswomen was correlated with a higher plasma cortisol concentration (P <0.05) and a lower plasma ACTH concentration (P <0.001) in this group. It is concluded that elite women basketball players have a greater phagocytic capacity than sedentary women, possibly mediated by the higher plasma cortisol concentration in the sportswomen.     

AMP-activated protein kinase enhances the phagocytic ability of macrophages and neutrophils

Although AMPK plays well-established roles in the modulation of energy balance, recent studies have shown that AMPK activation has potent anti-inflammatory effects. In the present experiments, we examined the role of AMPK in phagocytosis. We found that ingestion of Escherichia coli or apoptotic cells by macrophages increased AMPK activity. AMPK activation increased the ability of neutrophils or macrophages to ingest bacteria (by 46 ± 7.8 or 85 ± 26%, respectively, compared to control, P<0.05) and the ability of macrophages to ingest apoptotic cells (by 21 ± 1.4%, P<0.05 compared to control). AMPK activation resulted in cytoskeletal reorganization, including enhanced formation of actin and microtubule networks. Activation of PAK1/2 and WAVE2, which are downstream effectors of Rac1, accompanied AMPK activation. AMPK activation also induced phosphorylation of CLIP-170, a protein that participates in microtubule synthesis. The increase in phagocytosis was reversible by the specific AMPK inhibitor compound C, siRNA to AMPKα1, Rac1 inhibitors, or agents that disrupt actin or microtubule networks. In vivo, AMPK activation resulted in enhanced phagocytosis of bacteria in the lungs by 75 ± 5% vs. control (P<0.05). These results demonstrate a novel function for AMPK in enhancing the phagocytic activity of neutrophils and macrophages.     

Effect of bilirubin on the fungicidal capacity of human neutrophils

The effect of unconjugated bilirubin on the fungicidal capacity of human neutrophils was examined. Per cent Torulopsis glabrata killed in the presence of 1 x 10(-5) and 5 x 10(-5) M bilirubin was 72.7 +/- 2.5 and 40.9 +/- 7.2 respectively, compared to 81.4 +/- 4.1 in control (p less than 0.01 and p less than 0.001), respectively). This effect was not due to a concomitant inhibition of phagocytosis. The results suggest that jaundiced neonates may be more susceptible to fungal infections.     

Effect of nifedipine administration on the functional capacity of neutrophils

Administration of nifedipine to mice over a period of six months caused a significant (p<0.05) decrease in neutrophilic functions viz superoxide generation, coupled to NADPH oxidase activity as well as NADPH production by HMP shunt. Properties like chemotaxis and phagocytosis showed a similar decrease. From this study, it is seen that nifedipine causes neutrophil functional abrogation which is therefore an apparent concern for the prolonged usage of the drug. However, relevance of the mouse model to clinical situation needs further investigation.     

Hydrogen peroxide increases the phagocytic function of human neutrophils by calcium mobilisation

We have studied the effect of exogenous administration of hydrogen peroxide (H₂O₂) on phagocytic activity of human neutrophils. The treatment of cells with increasing concentrations of H₂O₂ evoke a significant elevation of phagocytic function assayed as phagocytic index, percentage and efficiency; and was similar to that induced by the calcium mobilising agonist formyl-methionyl-leucyl-phenylalanine (fMLP). This stimulatory effect was reduced by pre-treatment of neutrophils with catalase and abolished in neutrophils loaded with the intracellular calcium quelator dimethyl BAPTA. In the absence of extracellular calcium, treatment of cells with H₂O₂ resulted in a increase in [Ca²⁺] _i , indicating the release of calcium from intracellular stores. H₂O₂ abolished the typical calcium release stimulated by the physiological agonist fMLP, while depletion of agonist-sensitive calcium pools by fMLP was able to prevent H₂O₂-induced calcium release. We conclude that H₂O₂ induces calcium release from agonist-sensitive stores and consequently increase the phagocytosis process.     

System for testing the phagocytic capacity of human blood platelets

We have elaborated a system for testing the phagocytic activity of human blood platelets. Blood was sampled to heparin and ACD and centrifuged. This procedure yields platelet rich plasma (PRP). As a substrate for phagocytosis we used Staphylococcus aureus 209P. The ratio of platelets to bacteria is 1:1. Incubation of bacteria and platelets continued up to 10 minutes. Lysostaphine was introduced to the phagocytic system to destroy all bacteria outside the blood platelets. The maximal values for the percentage of phagocytizing blood platelets were 0.7% and the phagocytosis index of 1.0 was reached at 6 minutes with incubation of bacteria and platelets. The authors pay attention to the role of blood platelets in antibacterial mechanisms.     

Particle-induced myeloperoxidase release in serially diluted whole blood quantifies the number and the phagocytic activity of blood neutrophils and opsonization capacity of plasma.

Luminol-amplified chemiluminescence (CL) from phagocytes has previously been shown to be almost completely dependent on the release of myeloperoxidase (MPO) from azurophilic granules. We measured the luminol-amplified chemiluminescence response (WBCL) by using serially diluted whole blood. In these experiments, non-opsonized and serum-opsonized zymosan (NWBCL and OWBCL, respectively) were used concurrently as phagocytosable particles. We found two whole-blood dilution ranges with clinical significance: first, <0.04% of whole blood in the reaction volume, where MPO released by the zymosan-activated leukocyte population came almost totally from neutrophils and the OWBCL response could be exploited as a measure of a neutrophil count in a given blood specimen, despite the pathophysiological state of the host. In contrast, the NWBCL response was two-fold in blood samples from bacterial infection patients compared to those of controls and patients with viral infection, suggesting the use of NWBCL for the differential diagnosis of bacterial infections from viral infections; second, 0.16-1.2% of whole blood in the reaction volume, where the opsonization capacity of plasma (OC(50)) can be determined. We also found that at whole blood content >0.04%, erythrocytes quickly start to absorb chemiluminescence light, and that at whole blood content >1.2%, plasma proteins, most probably albumin and fibrinogen, start to inhibit MPO release.     

Evaluation of the phagocytic activity of peripheral blood neutrophils in patients with hyperthyroidism

In 80 women with hyperthyroidism (40 with diagnosed Graves disease and 40 with hyperactive nodular goiter) the following tests related to the function of peripheral blood neutrophils have been carried out: 1. nitrotetrazolium blue (NRT) reduction test. 2. evaluation of phagocyting activity by using latex particles and living bacteria cells, and 3. determination of immunoglobulin concentration and the C3 component of the complement in blood serum. The following features were found in the patients with hyperthyroidism: 1. the elevated values of the index of spontaneous NBT reduction which return to normal following the treatment with propranolol or metizol lasting 14 days, 2. a decrease in the phagocyting activity of neutrophils occurring with stimulation of phagocytosis by both the latex particles and bacteria cells. 3. the return to normal values of the index of neutrophils phagocyting the latex particles following two-week treatment with propranolol or metizol. It was concluded that in patients with hyperthyroidism the changes in NRT reduction and phagocyting activity of peripheral blood neutrophils return to normal following the two-week treatment of these patients with both propranolol and metizol.     

The effect of transferrin saturation on internal iron exchange

Radioiron was introduced into the intestinal lumen to evaluate absorption, injected as nonviable red cells to evaluate reticuloendothelial (RE) processing of iron, and injected as hemoglobin to evaluate hepatocyte iron processing. Redistribution of iron through the plasma was evaluated in control animals and animals whose transferrin was saturated by iron infusion. Radioiron introduced into the lumen of the gut as ferrous sulfate and as transferrin-bound iron was absorbed about half as well in iron-infused animals, and absorbed iron was localized in the liver. The similar absorption of transferrin-bound iron suggested that absorption of ferrous iron occurred via the mucosal cell and did not enter by diffusion. The decrease in absorption was associated with an increase in mucosal iron and ferritin content produced by the iron infusion. An inverse relationship (r = -0.895) was shown between mucosal ferritin iron and absorption. When iron was injected as nonviable red cells, it was deposited predominantly in reticuloendothelial cells of the spleen. Return of this radioiron to the plasma was only 6% of that in control animals. While there was some movement of iron from spleen to liver, this could be accounted for by intravascular hemolysis. Injected hemoglobin tagged with radioiron was for the most part taken up and held by the liver. Some 13% initially localized in the marrow in iron-infused animals was shown to be storage iron unavailable for hemoglobin synthesis. These studies demonstrate the hepatic trapping of absorbed iron and the inability of either RE cell or hepatocyte to release iron in the transferrin-saturated animal.