Serological analysis of patients treated with a new surgical hemostat containing bovine proteins and autologous plasma.

A randomized, controlled clinical study of the management of diffuse bleeding with CoStasis surgical hemostat, a new hemostat containing bovine thrombin and collagen with the patient's own plasma, included patients undergoing cardiac, hepatic, iliac, and general surgery. Sera from 92 patients treated with CoStasis and 84 control patients were collected preoperatively and at a post surgical follow-up of 8 weeks. Among the control group, 57 patients were treated with Instat collagen sponge in noncardiac indications. Results showed that antibody responses in the CoStasis clinical study were similar to the reported literature for all antigens screened and were not associated with any adverse reactions. The bovine thrombin preparations in CoStasis and other commercially available thrombins were compared with the use of SDS-PAGE and Western blot analyses. Within this clinical study, CoStasis was shown to be a safe and effective hemostatic product containing bovine thrombin and bovine collagen and no pooled human blood products.

Evaluation of a novel synthetic sealant for inhibition of cardiac adhesions and clinical experience in cardiac surgery procedures.

BACKGROUND: Pericardial adhesions subject patients requiring reoperation to potential injuries to the heart, great vessels, and cardiac grafts during the re-sternotomy. These adhesions can severely complicate re-operations by making re-entry hazardous, impeding orientation and visibility, increasing the amount of blood loss, and prolonging the operation time. The efficacy of an in situ-forming polyethylene glycol (PEG) material, CoSeal surgical sealant (CoSeal), for inhibiting cardiac adhesions in an animal model is reported. It is currently estimated that 10-20% of patients undergoing aortic valve replacement and coronary artery bypass grafting (CABG) will require a second operation later in their lives. Successful clinical experience using CoSeal for sealing suture lines of the aorta and CABGs with the data reported here suggest that CoSeal may have multiple applications in cardiac surgery. METHODS: In rabbits, a sternotomy and pericardiotomy were performed to expose the heart and the epicardium of the left ventricular surface. The epicardium was abraded for five minutes with dry gauze and cotton to develop punctate bleeding. In treated animals, CoSeal(R) or Tissucol(R) was applied directly to the abraded bleeding epicardium while retracting the pericardium. The pericardium was released, and the material over-sprayed to the cut edges of the pericardium. No material was applied in control animals. RESULTS: At necropsy, CoSeal(R) was found to significantly reduce the formation of adhesions, the tenacity of the adhesions, and the percent of the abraded site with adhesions as compared to surgical control and Tissucol. Tissucol showed no significant difference from the surgical control in any adhesion parameter. CoSeal treated hearts showed re-establishment of the mesothelial layer and tissue morphology similar to a normal un-operated heart. During the clinical cardiac procedures, CoSeal was easily mixed and applied to the suture lines of the aorta and coronary artery grafts. No bleeding was found at the suture lines. CONCLUSIONS: In the rabbit cardiac adhesion model, CoSeal significantly reduced the formation of adhesions as compared to surgical control and Tissucol, and demonstrated good biocompatibility. In CoSeal treated patients undergoing cardiopulmonary bypass or vessel repair, sealing was achieved comparable to previous cases using Tissucol fibrin sealant. CoSeal effectively sealed the suture lines of the aorta and coronary artery bypass grafts.

A tissue sealant based on reactive multifunctional polyethylene glycol.

A rapidly gelling synthetic tissue sealant was developed from tetra-succinimidyl and tetra-thiol-derivatized polyethylene glycol (PEG). The two reagents were dissolved in aqueous buffers at 20% (w/v) solids and sprayed on the tissue site, with the use of a sprayer/mixer device. Good adhesion to collagen membranes, PTFE grafts, and carotid artery was observed in vitro. In a burst test on collagen membranes with a 2-mm orifice defect, the gel sustained fluid pressures of 125 +/- 36 mm Hg (n = 18), fivefold greater than capillary blood pressure and one-half that observed in hypertension. On 0.4-mm-diameter puncture defects in PTFE grafts, pressures of 390-490 mm Hg were sustained, and on 0.6-0.9-mm puncture defects in carotid arteries, pressures of 490 to 840 mm Hg were sustained. In vitro data corresponded to results in vivo, where bleeding in rabbit arteries was stopped immediately in five out of six trials. A significant reduction in time to hemostasis and blood loss, compared to controls, was observed. Carotid artery and subcutaneous implant data in rabbits showed that the formula was compatible with biological tissue. Rapid gelling and effective sealing were dependent on the presence of active succinimidyl ester and thiol groups on PEG. HPLC and chemical substitution methods were useful in predicting whether batches of derivatized PEG would perform satisfactorily.

Role of PRL-3, a human muscle-specific tyrosine phosphatase, in angiotensin-II signaling.

Action of protein kinases and phosphatases contributes to myocardial hypertrophy. PRL-3, a protein tyrosine phosphatase, was identified in a cDNA library from an explanted human heart obtained from a patient with idiopathic cardiomyopathy. PRL-3 is expressed in heart and skeletal muscle, exhibiting approximately 76% identity to the ubiquitous tyrosine phosphatase PRL-1, which was reported to increase cell proliferation. PRL-3 was cloned into E. coli and purified using affinity chromatography. PRL-3 activity was determined using the substrate 6,8-difluoro-4-methylumbelliferyl phosphate, and was inhibited by vanadate and analogs. HEK293 cells expressing PRL-3 demonstrated increased growth rates versus nontransfected cells or cells transfected with the catalytically inactive C104S PRL-3 mutant. The tyrosine phosphatase inhibitor, potassium bisperoxo (bipyridine) oxovanadate V, normalizes the growth rate of PRL-3 expressing cells to that of parental HEK293 cells in a concentration-dependent manner. Using FLIPR analysis, parental HEK293 cells mobilize calcium when stimulated with angiotensin-II (AngII). However, calcium mobilization is inhibited in cells expressing wild-type PRL-3 when stimulated with AngII, while cells expressing the inactive mutant of PRL-3 mobilize calcium to the same extent as parental HEK293 cells. Western blots comparing PRL-3 transfected cells to parental HEK293 cells showed dephosphorylation of p130(cas) in response to AngII. These data suggest a role for PRL-3 in the modulation of intracellular calcium transients induced by AngII.

Treatment of suture line bleeding with a novel synthetic surgical sealant in a canine iliac PTFE graft model.

CoSeal mark surgical sealant (CoSeal) was evaluated for inhibiting suture line bleeding using a canine iliac PTFE graft model. Both iliac arteries of 12 heparinized canines were grafted with PTFE. CoSeal was applied to the suture lines of one graft in each animal. The contra-lateral graft served as a control and bleeding was controlled with gauze and pressure (tamponade). The cross-clamps were removed 30 s following application of CoSeal. Times to hemostasis and volume of blood loss at each graft site were determined. Compared to tamponade control, CoSeal significantly reduced the time to hemostasis (average of 5 min vs. greater than 15 min, p < 0.05) and blood loss (19 g vs. 284 g, p < 0.05). Small amounts of CoSeal were visible grossly or histologically at day 7. Histology showed moderate to marked inflammation in CoSeal sites and moderate inflammation in control sites at day 7. At 30 and 60 days, no CoSeal was visible grossly or histologically. Histology showed moderate inflammation in both CoSeal treated sites and in control sites at day 30 and mild to moderate inflammation in both CoSeal and control sites at day 60. CoSeal significantly reduced the time to hemostasis and blood loss in comparison to tamponade.

The effect of solvent extraction and sterilization procedure on the tissue response to Dacron velour.

The effects of solvent extraction and sterilization procedure on tissue response to Dacron velour were studied in a canine model, using histomorphometrical techniques. The solvents used for extraction of low molecular weight moieties were either ethanol or water: the sterilization techniques examined were ethylene oxide (ETO) treatment, steam sterilization, and radiofrequency glow discharge (RFGD) treatment. The effect of the sterilization procedure was most marked in the outermost regions (velour) of the implant; no sterilization effects were determined in the capsule or the knitted regions. Velour in the steam sterilized implants had the smallest blood vessel dimensions compared with those that were treated with ETO or RFGD. The effects of different extraction methodologies appeared to be more significant than sterilization effects and were detected further into the implant. That is, not only were extraction effects detected in the capsule and velour, they were also detected in the outer knitted region. Extraction with water resulted in histological responses considered more biologically desirable (thinner capsule, lower giant cell presence, and larger blood vessel diameters) than responses to extraction with ethanol. Neither extraction nor sterilization effects were detected in the inner layers of the knitted region, which were adjacent to the adhesive.

Increased protein kinase C activity and expression of Ca2+-sensitive isoforms in the failing human heart.

BACKGROUND: Increased expression of Ca2+-sensitive protein kinase C (PKC) isoforms may be important markers of heart failure. Our aim was to determine the relative expression of PKC-beta1, -beta2, and -alpha in failed and nonfailed myocardium. METHODS AND RESULTS: Explanted hearts of patients in whom dilated cardiomyopathy or ischemic cardiomyopathy was diagnosed were examined for PKC isoform content by Western blot, immunohistochemistry, enzymatic activity, and in situ hybridization and compared with nonfailed left ventricle. Quantitative immunoblotting revealed significant increases of >40% in PKC-beta1 (P<0.05) and -beta2 (P<0.04) membrane expression in failed hearts compared with nonfailed; PKC-alpha expression was significantly elevated by 70% in membrane fractions (P<0.03). PKC-epsilon expression was not significantly changed. In failed left ventricle, PKC-beta1 and -beta2 immunostaining was intense throughout myocytes, compared with slight, scattered staining in nonfailed myocytes. PKC-alpha immunostaining was also more evident in cardiomyocytes from failed hearts with staining primarily localized to intercalated disks. In situ hybridization revealed increased PKC-beta1 and -beta2 mRNA expression in cardiomyocytes of failed heart tissue. PKC activity was significantly increased in membrane fractions from failed hearts compared with nonfailed (1021+/-189 versus 261+/-89 pmol. mg-1. min-1, P<0.01). LY333531, a selective PKC-beta inhibitor, significantly decreased PKC activity in membrane fractions from failed hearts by 209 pmol. min-1. mg-1 (versus 42.5 pmol. min-1. mg-1 in nonfailed, P<0.04), indicating a greater contribution of PKC-beta to total PKC activity in failed hearts. CONCLUSIONS: In failed human heart, PKC-beta1 and -beta2 expression and contribution to total PKC activity are significantly increased. This may signal a role for Ca2+-sensitive PKC isoforms in cardiac mechanisms involved in heart failure.

Improved local delivery of TGF-beta2 by binding to injectable fibrillar collagen via difunctional polyethylene glycol.

To overcome rapid diffusion and clearance from the implant site and to increase stability, recombinant transforming growth factor beta2 (TGF-beta2) was covalently bound to injectable bovine dermal fibrillar collagen (FC) and its activity compared to admixed TGF-beta2. Covalent binding was achieved in a two-step procedure: First, TGF-beta2 was reacted with the difunctional polyethylene glycol (PEG) linker, and then the PEG-attached TGF-beta2 (PEG-TGF-beta2) was bound to the fibrillar collagen (FC-PEG-TGF-beta2). Initial binding of TGF-beta2 to difunctional succinimidyl glutarate (D-SG-PEG) or succinimidyl propionate polyethylene glycol (D-SE-PEG) linkers was completed after reacting for 8 or 10 min as monitored by reverse-phase high-performance liquid chromatography. After reaction with injectable fibrillar collagen, extraction of unbound PEG-TGF-beta2 and Western blot analysis, using a TGF-beta specific antibody, demonstrated that at least 85% of the TGF-beta2 was bound to the fibrillar collagen. The activity of PEG-TGF-beta2 was fully stable in phosphate-buffered saline at 4 degrees C and 37 degrees C for at least up to 4 weeks. Unmodified TGF-beta2 mixed with fibrillar collagen was completely inactivated after 1 week of incubation, as measured by the mink lung epithelial cell (Mv1Lu) growth inhibition assay. Formulations of FC-PEG-TGF-beta2 containing 40 microg/ mL TGF-beta2 were implanted subcutaneously into rats and analyzed after days 7, 21, and 42. All TGF-beta2-containing formulations showed the TGF-beta typical fibroblastic response at the day 7 time point. Covalent binding of TGF-beta2 to collagen with both difunctional PEG crosslinkers resulted in a significantly stronger and longer-lasting TGF-beta2 response than that observed with admixed formulations of collagen and TGF-beta. The TGF-beta response with FC-PEG-TGF-beta2 lasted up to day 42 but was not seen after day 7 for TGF-beta2 admixed to FC. These findings clearly demonstrate that TGF-beta2 remains fully active after being covalently bound to collagen via difunctional PEG. In addition, covalent binding potentiates and prolongs in vivo TGF-beta responses and stabilizes the TGF-beta in vitro. Results suggest that this method of formulation could be useful to stabilize and deliver similar peptide growth factors or biologically active agents.

The amyloidogenic peptide human amylin augments the inflammatory activities of eosinophils.

The amyloidogenic peptides, amyloid-beta (A beta) and human amylin, are the major constituents of amyloid deposits found in patients with the chronic degenerative disorders Alzheimer's disease (AD) and type 2 diabetes, respectively. Recent studies have shown that a variety of inflammatory proteins such as cytokines are associated with the amyloid deposits of AD brain tissues. Therefore, in the present study, we sought to determine whether A beta and/or human amylin could modulate the various inflammatory activities of eosinophils. We observed that human amylin but not A beta peptides inhibited the in vitro interleukin-5 (IL-5)-mediated survival of cord blood-derived eosinophils (CBEs) in a concentration-dependent manner. By contrast, rat amylin, a nonamyloidogenic peptide that is highly homologous to human amylin, failed to affect the IL-5-mediated survival of CBEs. Similar inhibitory effects of human amylin were observed for peripheral blood eosinophils. Human amylin also enhanced the release of the cytokine granulocyte-macrophage colony-stimulating factor by CBEs that were stimulated with the calcium ionophore A23187 but was incapable of directly stimulating CBEs to release cytokines. In addition, the A23187-induced release of the inflammatory lipid mediator leukotriene C4 by CBEs was augmented by human amylin. These results suggest that the amyloidogenic peptide human amylin is capable of amplifying the various inflammatory activities of eosinophils.

Antigen-induced recruitment of eosinophils: importance of CD4+ T cells, IL5, and mast cells.

Eosinophils of sensitized mice readily recruit to the site of antigen challenge. In the present study, experiments were performed to determine the involvement of different cell types in the antigen-induced recruitment of eosinophils. We demonstrated that a single treatment with anti-L3T4 monoclonal antibody (mAb) on the day of allergen challenge significantly decreased antigen-induced recruitment of eosinophils. Treatments with anti-L3T4 mAb during the sensitization period also caused a substantial reduction in the migration of eosinophils into the site of challenge with antigen. Thus, it appears that both stages of eosinophil recruitment, sensitization and antigen-challenge, are dependent upon the presence of L3T4+ T cells. Moreover, while treatments with anti-IL5 mAb blocked eosinophil migration, anti-IL2 mAb failed to alter the antigen-induced recruitment of eosinophils. In addition, significant numbers of eosinophils from the mast-cell-deficient mice were found to migrate into the peritoneal cavities upon allergen challenge. Eosinophil migration was also observed in several mouse strains of different H-2 haplotypes. The present findings suggest that CD4+ T cells and IL5 but not IL2 may play important roles in modulating the recruitment of eosinophils. Moreover, the involvement of mast cells does not appear to be essential for eosinophil migration. Finally, the development of antigen-induced recruitment of eosinophils is probably not under the immunogenetic regulation by genes within the H-2 complex.

FK506 and rapamycin modulate the functional activities of human peripheral blood eosinophils.

Numerous studies suggest that eosinophils may play a role in the inflammatory process of various diseases. Eosinophils are potent effectors of a variety of end-stage inflammatory activities. In addition, eosinophils are highly capable of synthesizing several cytokines which can stimulate the inflammatory responses of other cell types. Eosinophils are also responsive to a number of cytokines in that their in vitro survival as well as their effector functions can be enhanced by various cytokines. Finally, it is well established that the immunosuppressive drugs, FK506 and rapamycin, can inhibit the activation of T cells and mast cells. In the present study, the effects of FK506 and rapamycin on the activities of human peripheral blood eosinophils were investigated. It was first shown that human peripheral blood eosinophils upon stimulation with the calcium ionophore A23187 produced significant amounts of the cytokines, GM-CSF and IL3. FK506 was found to inhibit the synthesis of IL3 and GM-CSF, whereas rapamycin failed to suppress the cytokine production of eosinophils. Since FK506 and rapamycin are structurally related, the ability of rapamycin to reverse the FK506-mediated inhibition on cytokine production of eosinophils was next examined. It was observed that a 250-fold excess of rapamycin was required to antagonize the suppressive effects of FK506 on the cytokine secretion mediated by eosinophils. The capacity of rapamycin to alter the in vitro IL5-mediated survival of eosinophils was also studied. The results of this study demonstrated that rapamycin was effective in reducing the ability of IL5 to maintain the survival of eosinophils in culture; by contrast, FK506 had minimal effects on the IL5-mediated survival of eosinophils. In conclusion, the effects of FK506 and rapamycin on the activities of eosinophils appear to parallel those of mast cells and T cells. Hence, it is possible that FK506 and rapamycin might be acting on signal pathways or molecules that are shared by eosinophils, mast cells as well as T cells. Moreover, these findings suggest that both FK506 and rapamycin can potentially interfere with the capacity of eosinophils to engage in interactive activities that may contribute to the chronicity of inflammatory diseases such as asthma.

Effects of various anti-T cell receptor antibodies on the development of type II collagen-induced arthritis in mice.

Recent genetic studies of David and coworkers suggest that subsets of T cells utilizing specific V beta TcR genes may play important roles in the susceptibility to collagen-induced arthritis (CIA). Hence, in vivo depletion of such T cell subsets may significantly affect the development of CIA. To address this possibility, we first examined the effects of in vivo treatments with various monoclonal antibodies (mAbs) that are specific for particular TcR V beta families on the induction of CIA. Results presented in this study demonstrated that treatments with either anti-V beta 6, anti-V beta 8 or anti-V beta 11 did not suppress the development of arthritis in collagen-immunized mice. While combined treatments with these V beta specific mAbs which resulted in the in vivo elimination of V beta 6+, V beta 8+ and V beta 11+ T cells were not very effective in preventing the onset of CIA, the severity of the arthritic disease was somewhat reduced in animals that had received the triad of anti-V beta mAbs. By contrast, depletion of T cells expressing the alpha beta receptors by in vivo treatments with a pan anti-alpha beta mAb significantly decreased the incidence of CIA. Therefore, although an effect on the development of CIA was achieved by in vivo treatments with a mAb that detects all alpha beta + T cells, the elimination of only a few subsets of T cells which included the V beta 6+, V beta 8+, and V beta 11+ cells did not profoundly alter the incidence of CIA.(ABSTRACT TRUNCATED AT 250 WORDS)

Interleukin-1 enhances the development of type II collagen-induced arthritis only in susceptible and not in resistant mice.

The development of type II collagen-induced arthritis (CIA) in DBA/1 mice is readily accelerated by treatments with interleukin-1 beta (IL-1 beta). In an attempt to further characterize this IL-1 beta-mediated enhancement of CIA, we first examined the effects of IL-1 beta treatments in other "CIA-susceptible" strains and "CIA-resistant" mice. It was observed that treatments with IL-1 beta also enhanced the onset of arthritis in two B10 recombinant CIA-susceptible strains, B10.T (6R) and B10.DA, and in the SJL mice which develop CIA with a relatively low and variable incidence. On the other hand, IL-1 beta failed to augment the expression of arthritic disease in several CIA-resistant strains. We also investigated the potentiating effects of IL-1 beta in mice that were depleted of L3T4+ T cells. It was found that the ability of IL-1 beta to accelerate the development of CIA was significantly reduced in DBA/1 mice pretreated with the monoclonal anti-L3T4 antibody. In further studies, we demonstrated that the induction of CIA upon transfer with collagen-primed spleen cells was also augmented by IL-1 beta, and this enhancing effect by IL-1 beta on the adoptive transfer of CIA was associated with a significant increase in the levels of serum anti-collagen antibodies. Moreover, IL-1 beta treatments did not potentiate the induction of CIA in mice that were transferred with either collagen-immune splenic cells that were depleted of L3T4+ T cells or only T cells obtained from collagen-immunized animals. However, IL-1 beta enhanced the development of arthritis in animals that had been transferred with two subpopulations of collagen-immune cells: (i) enriched T cells and (ii) splenic cells that were depleted of L3T4+ T cells. Thus, IL-1 beta potentiated the inflammatory responses in animals that were genetically predisposed to developing arthritis. In contrast, IL-1 beta was incapable of accelerating the development of arthritis in various mouse strains that were genetically resistant to CIA. The administration of IL-1 beta also failed to potentiate the development of CIA in L3T4-deficient mice or in animals transferred with collagen-primed spleen cells that were depleted of L3T4+ T cells. These results indicate that IL-1 beta readily accelerates the induction of arthritis when the disease is present, but that IL-1 beta is incapable of promoting the expression of the arthritis in the absence of underlying disease.

Quantification of vascular ingrowth into Dacron velour.

Evaluation of vascular ingrowth into Dacron velour was performed to compare methods and to determine the amount of vascular ingrowth. Microcasting and direct measurement were compared based on their ability to quantify ingrowth, the type of information obtainable, and the time required for data acquisition. Microcasting did not produce results indicative of the actual vascular ingrowth; however, direct measurement of histological slides gave quantifiable data for comparing vascular ingrowth.

Two subsets of cloned T helper cells exhibit different activation requirements and characteristics.

An anti-clonotypic monoclonal antibody (mAb 211G7H) was generated against a T helper cell clone which specifically recognized type II collagen. Besides inhibiting the proliferative response of the immunizing T cell clone to type II collagen, mAb 211G7H (soluble form) also suppressed the antigen-induced proliferation of several other T cell clones which shared similar specificity for antigen and major histocompatibility complex with the immunizing T cell clone. On the other hand, mAb 211G7H did not inhibit the responses of clones exhibiting different antigenic specificities from the clonotype-positive T cell clones. It was also demonstrated that these clonotype-positive T cell clones responded differently to mAb 211G7H when it was immobilized. Based upon their proliferative responses to immobilized anti-clonotype 211G7H mAb, two subpopulations of T cell clones were defined. Collagen-specific T cell clones of the first group proliferated poorly when stimulated with immobilized anti-clonotype mAb, by contrast, T cell clones belonging to the second group proliferated well to immobilized mAb. Furthermore, upon stimulation with immobilized 211G7H mAb, the second subpopulation of cloned T cells produced both interleukin (IL) 2 and IL4, while the first group secreted IL2 but not IL4. The cloned T cells from the group which responded weakly to immobilized anti-clonotype mAb also mediated reduced proliferative responses to IL2 in the presence of immobilized 211G7H mAb. Finally, these two subsets of T cell clones were found to respond differently to other non-antigen stimuli such as IL4 and phorbol 12-myristate 13-acetate. Thus, from a panel of collagen-specific T cell helper clones which had similar receptor fine specificities, we have isolated two subsets of cloned T helper cells that displayed different activation requirements and lymphokine production.

A comparison of three techniques to quantify vascular ingrowth into Dacron velour.

Three methods of evaluation of vascular ingrowth into treated and untreated Dacron velour were performed to compare the methods. Vascular casting, direct measurement, and stereology were compared based on their ability to quantitate ingrowth, the type of information obtainable, and the time required for data acquisition. Results show that with the methods used in this study vascular casting was not able to produce data indicative of the actual vascular ingrowth. Direct measurement and stereological measurements of histological slides were able to give hard data for comparing ingrowth. However, stereological measurements were easier and less time-consuming to perform. In addition, stereological measurements were able to reveal additional parameters quickly.